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Liu J, Su D, Qin S, Ye B, Wang B, Pang Y. Evaluation of the Association Between Coronary Artery Aneurysms and Concomitant Infection in Patients With Kawasaki Disease. Clin Pediatr (Phila) 2024; 63:785-797. [PMID: 37642409 DOI: 10.1177/00099228231196526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
We analyzed the relationship between recovery from coronary artery aneurysms (CAAs) and concurrent infections in patients with Kawasaki disease (KD). The estimated median time of aneurysm persistence between patients with and without infections was compared using Kaplan-Meier survival analyses. Risk factors associated with persistent CAAs at 2 years were identified using multivariable analyses. Co-infection was confirmed in 20.5% (106/518) of patients diagnosed with KD. No significant differences regarding treatment or coronary artery outcome were identified between patients with and without infections. The estimated median time of aneurysm persistence was higher in the co-infected group (9 vs. 6 months). A maximum Z-score ≥ 4.00 at 1 month had 78% sensitivity and 83% specificity in predicting CAAs without recovery within 1 year of onset, whereas the predictability was higher within 2 years of onset, with a Z-score ≥ 4.88 (sensitivity, 92%; specificity, 91%). Concomitant infections did not affect the response to treatment or coronary artery outcomes in patients with KD.
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Affiliation(s)
- Jie Liu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Danyan Su
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baofeng Wang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Wu Y, Wang S, Zhou Y, Yang Y, Li S, Yin W, Ding Y. Clinical indicators combined with S100A12/TLR2 signaling molecules to establish a new scoring model for coronary artery lesions in Kawasaki disease. PLoS One 2023; 18:e0292653. [PMID: 37824465 PMCID: PMC10569519 DOI: 10.1371/journal.pone.0292653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Coronary artery lesions (CALs) are the most common and serious complication of Kawasaki disease (KD), and the pathogenesis is unknown. Exploring KD-specific biomarkers and related risk factors is significant for clinical diagnosis and treatment. This study aimed to explore the feasibility of combining clinical indicators with S100A12/TLR2-associated signaling molecules for the predictive modeling of CALs in KD. A total of 346 patients (224 males and 122 females) with KD who visited the rheumatology department of Wuhan Children's Hospital between April 2022 and March 2025 were enrolled and divided into two groups according to the presence or absence of CALS (292 patients had CALs and 54 patients did not). Forty-one variables were collected from the two groups, including demographic characteristics, clinical manifestations, and laboratory data. Single nucleated cells from each patient were extracted, and the expression of the S100A12/TLR2 signal transduction-related molecules S100A12, TLR2, MYD88, and NF-κB were detected by real-time fluorescent quantitative polymerase chain reaction. Statistically significant variables were subjected to logistic regression analysis to determine the independent risk factors for KD with CALs, and a new risk score model was established to assess the predictive efficacy based on receiver operating characteristic curves. Sixteen variables significantly differed between the no-CALs and CALs groups: gender, fever duration, white blood cells (WBC), hemoglobin (HGB), Ce reactive protein (CRP), procalcitonin, serum ferritin (SF), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), aspartate aminotransferase-to-alanine aminotransferase ratio (AST/ALT), serum albumin (ALB), sodium (Na), Interleukin (IL-10), tumor necrosis factor (TNF-α), S100 calcium binding protein A12 (S100A12), and Myeloid Differentiation Factor 88 (MYD88) (p < 0.05). After performing a univariate analysis, 12 variables (gender, fever duration, WBC, HGB, CRP, SF, ESR, FIB, AST/ALT, ALB, Na, and S100A12) were included in the multifactorial binary logistic regression, which showed that fever duration ≥ 6.5 days, ESR ≥ 46.5 mm/h, AST/ALT ≤ 1.51, and S100A12 ≥ 10.02 were independent risk factors for KD with CALs and were assigned scores of 3, 2, 1, and 2, respectively, according to the odds ratio (OR). The total score of each patient was counted, and a new prediction model for KD combined with CALs was established, where < 3.5 was considered low risk and ≥ 3.5 was regarded as high risk; the sensitivity, specificity, Jorden index, and area under the curve of this scoring system were 0.667, 0.836, 0.502, and 0.838, respectively. This new scoring model has good efficacy for predicting the occurrence of KD with CALs. The expression of S100A12 was significantly increased in the CALs group and was an independent risk factor for the occurrence of CALs, and has the potential as a biomarker for predicting KD with CALs.
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Affiliation(s)
- Yali Wu
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Shasha Wang
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yang Zhou
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Youjun Yang
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Shiyu Li
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Wei Yin
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yan Ding
- Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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van Stijn D, Korbee JM, Netea SA, de Winter VC, Zwinderman KAH, Kuipers IM, Kuijpers TW. Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis. J Pediatr 2022; 243:167-172.e1. [PMID: 34968497 DOI: 10.1016/j.jpeds.2021.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess whether 'treatment day' is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG). STUDY DESIGN Patient data from (n = 1016) a single center were collected for an observational cohort study. After exclusions, we retrospectively analyzed 776 patients in total. A multivariate analysis was performed with treatment day as a continuous variable (n = 691). Patients were categorized as no enlargement, small CAA, medium CAA, and giant CAA. RESULTS Late treatment per-day was a significant predicting factor for the development of larger CAAs. ORs for medium and giant CAAs per delayed day were 1.1 (95% CI 1.1-1.2) P < .05 and 1.2 (95% CI 1.1-1.2) P < .05, respectively. CONCLUSION We showed that every day of delay in treatment of patients with Kawasaki disease inherently carries a risk of medium and giant aneurysm formation. There was no cut-off point for treatment day that could mark a safe zone.
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Affiliation(s)
- Diana van Stijn
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Justin M Korbee
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stejara A Netea
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vera C de Winter
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Department of Public Health and Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Çakmak F, Demir F, Çakan M, Sonmez HE, Çağlayan Ş, Karadağ ŞG, Varlı YZ, Otar Yener G, Öztürk K, Sözeri B, Aktay Ayaz N. Is it all about age? Clinical characteristics of Kawasaki disease in the extremely young: PeRA research group experience. Postgrad Med 2022; 134:429-434. [PMID: 35324413 DOI: 10.1080/00325481.2022.2058206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES : In the evaluation of children with Kawasaki disease (KD), the age of onset is important and complications may occur if the distinctive features are not assessed accordingly. The objective of the study is to define the clinical and laboratory presentations and treatment outcomes of KD in infants ≤6 months of age compared to those >6 months multicentrically. METHODS : This retrospective study reviewed the medical records of the patients diagnosed with KD and followed up between January 2009 and January 2019. RESULTS : A total of 204 KD patients were enrolled and grouped according to age as Group I (≤6 months, n=31) and Group II (>6 months, n=173). Except for cervical adenopathy (19.3% vs. 47.4%, p=0.03), the major clinical manifestations of KD were similar between groups I and II. However, the frequency of incomplete and atypical KD was higher in Group I (38.7% vs. 24.8%, p=0.04, 38.7% vs. 8.1% p<0.001, respectively). Clinical features such as vomiting/diarrhea (19.3% vs. 1.1% p<0.001), aseptic meningitis (19.3% vs. 2.3%, p=0.001) were more common in Group I. Percentage of neutrophils (45.5 vs. 36, p=0.004) and hemoglobin levels (8 vs. 10.5 gr/dL, p=0.02) were statistically lower and platelet count (737000 vs 400000/mm3, p=0.004) was statistically higher in group I. Coronary artery lesions (CALs) were more common in Group I (48% vs. 20 %, p<0.001). Harada and Kobayashi scores appear to be effective in predicting coronary artery lesions (CALs) and IVIG resistance in the entire cohort. There was no diagnostic delay in group I (5.5 vs 6.5 days, p=0.88). CONCLUSIONS : Since clinical presentations and laboratory features of KD may vary with age, and the frequency of atypical and incomplete presentations is high, awareness of KD in young children should be raised among pediatricians.
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Affiliation(s)
- Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Kocaeli University Medical School, Kocaeli, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Yusuf Ziya Varlı
- Department of Pediatrics, Istanbul Basaksehir City Hospital, Istanbul, Turkey
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Goztepe Prof. Dr Suleyman Yalcın City Hospital,Istanbul Medeniyet University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Fatih, Istanbul, Turkey
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Cheah CS, Lee WWL, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Kawasaki disease in Malaysia: Biochemical profile, characterization, diagnosis and treatment. Front Pediatr 2022; 10:1090928. [PMID: 36714643 PMCID: PMC9880227 DOI: 10.3389/fped.2022.1090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the East Asian countries. Nevertheless, to date, the data on KD in Malaysia are limited. This study aimed to evaluate the epidemiology, clinical features, treatment, and outcomes of KD among the pediatric patients admitted to Hospital Canselor Tunku Muhriz (HCTM), Kuala Lumpur, Malaysia. METHOD A retrospective cohort study of 66,500 pediatric patients presented at HCTM from the year 2004 to 2021 was conducted. RESULTS 62 KD cases out of 66,500 pediatric admissions were reported, with a male-to-female ratio of 1.58 to 1. Majority of KD patients (95.0%) were younger than 5 years old. Prior infection was reported in 5 KD patients (8.1%). Apart from the classical features, manifestations of various organ systems including cardiovascular (16.1%), gastrointestinal (43.5%), neurological (1.61%), musculoskeletal (1.61%), and genitourinary (17.7%) systems were observed. There was a significant association between sterile pyuria and coronary artery aneurysm (CAA) (p < 0.05). Interestingly, abnormal liver parameters (p < 0.05) and incomplete KD (p < 0.05) were significantly related to IVIG resistance. DISCUSSION The presence of family history, immunological disorder, and previous infection in our KD patients suggested that there is a possibility of genetic, immunological, and infectious roles in the pathophysiology of KD. IVIG resistance is more likely to occur in KD patients with hepatic dysfunction or incomplete KD presentation. These findings highlighted the significant contribution of laboratory parameters to the prognosis of KD, prompting more in-depth research on the KD scoring systems and their relevance in this country.
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Affiliation(s)
- Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wendy Wei Li Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohammad Shukri Khoo
- Department of Pediatric, Universiti Kebangsaan Malaysia Specialist Children's Hospital (HPKK), Kuala Lumpur, Malaysia
| | | | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Pediatric, Universiti Kebangsaan Malaysia Specialist Children's Hospital (HPKK), Kuala Lumpur, Malaysia
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Li W, Zhang L, Wang Z, He X, Lin H, Wang Y, Yuan J, Xie X, Zhang X, Qin Y, Huang P. Predictors for Intravenous Immunoglobulin Resistance in Patients with Kawasaki Disease. Int J Clin Pract 2022; 2022:2726686. [PMID: 35989868 PMCID: PMC9365590 DOI: 10.1155/2022/2726686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Between 10 and 20% of Kawasaki disease (KD) patients are resistant to treatment with initial intravenous immunoglobulin (IVIG) and have a high risk of developing coronary artery lesions. Some studies have been conducted to identify predictive factors. However, the results are controversial. This study aims to identify the risk factors for IVIG-resistant KD patients in a Chinese population. METHODS We performed a retrospective analysis of medical records of consecutive KD patients from two medical centers in South China from January 2015 to December 2017. A total of 1281 KD patients were eligible for inclusion in this study and maintained follow-up for over 12 months. The KD patients were divided into two groups based on IVIG response. Clinical characteristics and laboratory variables were compared between the two groups. Multivariate logistic regression analysis was performed to identify the risk factors of IVIG resistance in KD patients. RESULTS Of the 1281 KD patients, 141 (11.0%) cases who were IVIG resistant to adjunctive therapies for primary treatment were classified as group 1. The remaining patients were in group 2 (n = 1140), classified as the control group. There was a significant difference in male to female ratio and the length of hospital stay between the two groups (P < 0.05). Group 1 had a higher white blood cell count (P=0.01) and C-reactive protein level (P < 0.01) before IVIG treatment than in group 2. Group 1 had a significantly higher white blood cell count and percentage of neutrophils after the IVIG infusion than in group 2 (P < 0.001). In addition, the mean values of C-reactive protein level and neutrophil percentage before and after treatment difference comparison were significantly different. Multivariate analysis showed that patients presenting with coronary artery lesions in the acute phase and a C-reactive protein level >100 mg/L at diagnosis were associated with IVIG resistance in KD. During the 12-month follow-up period, group 1 had an obviously higher incidence of coronary artery lesions than group 2, and the difference between the groups was statistically significant (P < 0.001). CONCLUSIONS Patients presenting with coronary artery lesions in the acute phase and elevated C-reactive protein levels before IVIG treatment might be a useful and important value for predicting IVIG resistance in KD. Risk assessment based on coronary artery lesions and C-reactive protein levels prior to the treatment may improve the outcome of IVIG resistance.
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Affiliation(s)
- Wei Li
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Zhouping Wang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiufang He
- Department of Pediatric Cardiovascular, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Huimei Lin
- Department of Medical Record, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Yanfei Wang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Jia Yuan
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaofei Xie
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xu Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Youzhen Qin
- Department of Pediatric Cardiovascular, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ping Huang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
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Guo C, Tan C, Xia X, Yuan Y, Zhao M, Yuan Z, Wang Y, Deng Z, Chen J, Zhou Y, Huang Y. Tumour necrosis factor-α and myoglobin associated with the recovery time of coronary artery lesions in Kawasaki disease patients. J Paediatr Child Health 2020; 56:1382-1387. [PMID: 32479688 DOI: 10.1111/jpc.14942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/20/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess the relationship between clinical parameters and medium term recovery time of coronary artery lesions (CALs). METHODS In total, 344 Kawasaki disease patients were screened and 311 Kawasaki disease patients were included and followed-up for the next 2 years. Clinical records, clinical parameters and inflammatory biomarkers were collected for all subjects. RESULTS Tumour necrosis factor (TNF)-α and myoglobin (MYO) levels in patients without recovery from CALs were significantly higher than those without CALs and with recovery from CALs. Kaplan-Meier survival analysis showed that in the high-TNF-α group, the estimated median time to recovery (5.0 months, 95% confidence interval (CI) 1.436-8.564) is significantly longer than the low-TNF-α group (2.00 months, 95% CI: 0.633-3.367, P = 0.044). Also, the estimated median time (5.0 months, 95% CI: 1.836-8.164) in the high-MYO group is significantly longer than the low-MYO group (2.00 months, 95% CI: 0.405-3.595, P = 0.002). Cox regression analysis showed independent factors for recovery of CALs included age, left coronary artery to aortic annulus ratio, TNF-α and MYO levels. CONCLUSIONS These findings suggest that clinical parameters such as age, left coronary artery to aortic annulus ratio, TNF-α and MYO levels associate with medium term recovery time of CALs and could help in the design of a clinical strategy for the surveillance and prevention of late cardiovascular events.
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Affiliation(s)
- Chun Guo
- Children's Medical Center, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Chaochao Tan
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Xiaohui Xia
- Ultrasound Department, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Yonghua Yuan
- Children's Medical Center, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Menghua Zhao
- Children's Medical Center, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Zhijie Yuan
- Children's Medical Center, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Yupeng Wang
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Zhonghua Deng
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Jie Chen
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Yujie Zhou
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
| | - Ying Huang
- Department of Emergency, Hunan Provincial People's Hospital, the First Affiliated Hospital, Hunan Normal University, Changsha, China
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Abstract
We report a case of a 2-month-old infant with incomplete Kawasaki disease with multiple coronary and systemic arteries aneurysms complicated with internal iliac arteries thrombosis. The atypical clinical presentations and severity of systemic vascular involvements discuss the importance of high index of suspicions in younger infants and treatment options in such cases.
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Li W, Zhang L, Huang P, Zhang Z. Clinical features and mid-term follow-up in infants younger than 3 months with Kawasaki disease in a Chinese population. J Paediatr Child Health 2019; 55:523-527. [PMID: 30246351 DOI: 10.1111/jpc.14233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical features and mid-term follow-up of Kawasaki disease (KD) in infants younger than 3 months of age in a Chinese population. METHODS We performed a retrospective analysis of clinical signs, laboratory data, echocardiography results and outcomes for patients with KD diagnosed at our hospital from January 2009 to December 2013. A total of 1150 children were diagnosed with KD, and 200 KD patients were enrolled in this study. Group 1 included 40 children younger than 3 months of age. We randomly selected a control group as Group 2 included 160 children older than 3 months of age who fulfilled diagnostic criteria for KD and maintained follow-up for more than 1 year. RESULTS There was a significant difference in clinical manifestations between the two groups, except respiratory infection. Group 1 was more likely to have incomplete presentation (P < 0.001). There were no significant differences in laboratory data except for white blood cell counts between the two groups. Coronary artery abnormalities were significantly different between the two groups (P < 0.001). At a mean follow-up of 18 months (range 12-48 months), all patients with coronary artery abnormalities, except for giant coronary aneurysms, returned to normal in terms of diameter as assessed by echocardiography. CONCLUSIONS Infants younger than 3 months of age with KD often present with incomplete criteria, and diagnosis may be delayed. In addition, there may be a higher risk of developing coronary artery abnormalities. All patients except those with giant coronary aneurysms recovered well without complications at mid-term follow-up.
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Affiliation(s)
- Wei Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Affiliated South China Hospital, Southern Medical University, Guangdong General Hospital, Guangzhou, China.,Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ping Huang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Affiliated South China Hospital, Southern Medical University, Guangdong General Hospital, Guangzhou, China
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10
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Lu Z, Xu Y, Fu L, Tan Y, Che D, Huang P, Pi L, Zhou H, Liang X, Zhang L, Gu X. P2RY12:rs7637803 TT variant genotype increases coronary artery aneurysm risk in Kawasaki disease in a southern Chinese population. J Gene Med 2019; 21:e3066. [PMID: 30576025 DOI: 10.1002/jgm.3066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/16/2018] [Accepted: 11/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Activated-platelet increases the risk of thrombosis in Kawasaki disease (KD) patients with a coronary artery aneurysm (CAA). The ADP pathway is one of the platelet activation and aggregation pathways. The P2RY12 gene encodes the ADP receptor that is highly concentrated on platelets. However, few studies have reported on P2RY12 in relation to KD susceptibility with or without CAA. METHODS We recruited 1335 healthy controls and 776 KD patients, including 103 with CAA, and selected five P2RY12 polymorphisms: rs9859538, rs1491974, rs7637803, rs6809699 and rs2046934. The present study focused on the relationship between the P2RY12 polymorphisms and KD with or without CAA. RESULTS Among all of the selected polymorphisms, single-locus analysis showed no significant association between the P2RY12 polymorphism and KD susceptibility. However, we found a significant relationship between rs7637803 and CAA risk in KD patients [CT versus CC: odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; p = 0.0041; TT versus CC: OR = 2.90, 95% CI = 1.12-7.46; p = 0.0276]. Stratification analysis by age in KD patients indicated that the rs7637803 TT genotype increased CAA formation risk among children aged (OR = 3.90, 95% CI = 1.42-10.69; p = 0.0081) and increased the onset risk of CAA in males (OR = 6.28, 95% CI = 2.01-19.65; p = 0.0016). The combined effect of the five selected P2RY12 risk genotypes with the KD patients compared to non-mutated P2RY12 genotypes (score: 0) showed that patients with P2RY12 genotype polymorphisms (score: 1-5) had a significantly increased CAA risk (p = 0.0086). Stratification analysis for the severity of CAA found that the rs7637803 TT genotype reduced giant CAA (GCAA) risk (OR = 4.60, 95% CI = 1.70-12.41; p = 0.0026). CONCLUSIONS The results of the present study indicate that the P2RY12 rs7637803 genotype might be used as a biomarker to predict the occurrence of GCAA.
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Affiliation(s)
- Zhaoliang Lu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yufen Xu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lanyan Fu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaqian Tan
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Di Che
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ping Huang
- Department of cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lei Pi
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huazhong Zhou
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoyun Liang
- Department of Clinical Lab, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li Zhang
- Department of cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoqiong Gu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Clinical Lab, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Li X, Chen Y, Tang Y, Ding Y, Xu Q, Sun L, Qian W, Qian G, Qin L, Lv H. Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a meta-analysis of 4442 cases. Eur J Pediatr 2018; 177:1279-1292. [PMID: 29948255 PMCID: PMC6061038 DOI: 10.1007/s00431-018-3182-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ≤ 4.0 days after the onset of symptoms were more likely to be IVIG resistant. CONCLUSION The initial administration of IVIG ≤ 4.0 days after the onset of symptoms increased ESR and decreased hemoglobin and platelet counts, oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, and polymorphous rash and are the risk factors for IVIG-resistant Kawasaki disease. What is Known: • Recent reports on this topic are about aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase, total bilirubin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), polymorphonuclear leukocytes (PMN), C-reactive protein (CRP), pro-brain natriuretic peptide (BNP), albumin, and sodium as the risk factors in the IVIG-resistant Kawasaki disease; however, no studies have been published on clinical features as predictors of IVIG resistance. What is New: • This meta-analysis identified the clinical features, the initial administration of IVIG ≤ 4.0 days after the onset of symptoms, and much more comprehensive laboratory indicators, such as hemoglobin, as predictors of IVIG-resistant Kawasaki disease.
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Affiliation(s)
- Xuan Li
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Ye Chen
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yunjia Tang
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yueyue Ding
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Qiuqin Xu
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Lin Sun
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Weiguo Qian
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Guanghui Qian
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, 215003, China.
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Difference in Risk Factors for Subtypes of Acute Cardiac Lesions Resulting from Kawasaki Disease. Pediatr Cardiol 2017; 38:375-380. [PMID: 27878631 DOI: 10.1007/s00246-016-1525-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022]
Abstract
Few studies discuss the risk factors for acute cardiac lesions (within 30 days) resulting from Kawasaki disease (KD). We aimed to clarify the characteristics of patients with cardiac lesions within 30 days and determine the risk factors for acute cardiac lesion subtypes. Using the 23rd nationwide survey of KD in Japan, we analyzed data from patients with or without acute cardiac lesions resulting from KD (n = 31,380). We subdivided patients with acute cardiac lesions into three types: acute valvular lesions, coronary aneurysms, and giant coronary aneurysms (GCA), and calculated the odds ratios of potential risk factors for acute cardiac lesion subtypes. The prevalence of acute cardiac lesions was 8.6%, and these lesions were more prevalent among males than females (1.98:1). Male sex, age <1 year, and atypical definite cases predicted coronary artery lesions (CAL). The risk factors for valvular lesions differed from the risk factors for CALs, but GCA risk factors were similar to CAL risk factors: age <1 year, later presentation to hospital, atypical definite cases, and resistance to initial intravenous immunoglobulin (IVIG) therapy. Resistance to IVIG therapy was a significant risk factor for acute GCA. We found differences in cardiac lesion risk factors within 30 days of diagnosing KD between acute CAL and valvular lesions resulting from KD. In particular, pediatricians should consider atypical definite cases and resistance to initial IVIG when assessing the risk of acute-phase GCA.
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Yoon YM, Yun HW, Kim SH. Clinical Characteristics of Kawasaki Disease in Infants Younger than Six Months: A Single-Center Study. Korean Circ J 2016; 46:550-5. [PMID: 27482265 PMCID: PMC4965435 DOI: 10.4070/kcj.2016.46.4.550] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/12/2015] [Accepted: 10/27/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Kawasaki disease (KD) is the leading cause of acquired heart disease, which predominantly occurs in children under the age of 5 years. However, there are fewer cases of KD in infants younger than 6 months, which makes it difficult to diagnose. We investigated the clinical manifestations of KD in this age group and compared them with those in the older age group. SUBJECTS AND METHODS We retrospectively reviewed the medical records of 239 patients with KD admitted to the Hallym Sacred Heart Hospital from January 2013 to June 2015. The data were categorized into 2 groups by age: Group A (≤6 months, n=26) and Group B (>6 months, n=213). RESULTS Group A had a longer hospitalization period than Group B (6.69 vs. 5.19 days, p=0.002). Group A had fewer clinical manifestations upon admission, due to which there was a higher incidence of incomplete KD (1.88 vs. 3.54 of the diagnostic criteria, p<0.05; and 19.2% vs. 4.2% incomplete KD incidence, p=0.002). The rate of cardiac complications was higher in Group A (30.8% vs. 11.7%, p=0.011). CONCLUSION The rate of cardiac complications of the patients younger than 6 months was significantly higher than that of the older patients. Therefore, infants younger than 6 months with unexplained fever for more than 5 days should be suspected as having KD, even if the principal clinical features are not fully presented. Echocardiography must be appropriately used for diagnosis of KD in suspected patients.
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Affiliation(s)
- You Min Yoon
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye Won Yun
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Hye Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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