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Morana E, Guida F, Andreozzi L, Frazzoni L, Baselli LA, Lami F, Corinaldesi E, Cicero C, Mambelli L, Bigucci B, Taddio A, Ghizzi C, Cappella M, Fernicola P, Lanari M, Zagari RM, Fabi M. Coronary Arteries Lesions in Kawasaki Disease: Risk Factors in an Italian Cohort. Biomedicines 2024; 12:2010. [PMID: 39335523 PMCID: PMC11429242 DOI: 10.3390/biomedicines12092010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/21/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Kawasaki disease (KD) is a systemic vasculitis of medium arteries, particularly involving coronary arteries. Coronary artery lesions (CALs) is the most serious complication in the acute stage, potentially leading to ischemic cardiomyopathy, myocardial infarction and sudden death. Environmental factors and genetic background contribute to individual susceptibility to develop CALs. The aim of this study was to define the risk factors for CALs in an Italian cohort. Methods: Data of KD patients from 10 Italian sites were registered into a REDCap database where demographic and clinical data, laboratory findings and coronary status were recorded. KD was diagnosed according to AHA definition. We used multiple logistic regression analysis to identify independent risk factors for CALs. Results: A total of 517 patients were enrolled, mainly Caucasians (83.6%). Presentation was complete in 321 patients (62.8%) and IVIG responsiveness in 360 (70%). CALs developed in 136/517 (26.31%). Gender, age, ethnicity, clinical presentation, fever duration, non-coronary cardiac events, Hb, albumin and CRP were significantly different between patients with and without CALs, while seasonality was not. Male gender, age < 18 months, Asian ethnicity, incomplete presentation and fever > 10 days were independent risk factors for CALs. Conclusions: Age younger than 18 months, incomplete KD and longer fever duration are risk factors for CALs. Asian ethnicity also represents a risk factor in our Italian Cohort.
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Affiliation(s)
- Elisabetta Morana
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Fiorentina Guida
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Andreozzi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Leonardo Frazzoni
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | - Lucia Augusta Baselli
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122 Milan, Italy
| | - Francesca Lami
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Cristina Cicero
- Department of Pediatrics, AUSL, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Lorenzo Mambelli
- Department of Paediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, 48121 Ravenna, Italy
| | - Barbara Bigucci
- Pediatric Clinic, Rimini Hospital, AUSL Romagna, 47923 Rimini, Italy
| | - Andrea Taddio
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" and University of Trieste, 34137 Trieste, Italy
| | - Chiara Ghizzi
- Pediatric Unit, AUSL Bologna, Ospedale Maggiore, 40133 Bologna, Italy
| | - Michela Cappella
- Pediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paola Fernicola
- Pediatrics Unit, G.B. Morgagni-L. Pierantoni Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47121 Forlì, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rocco Maurizio Zagari
- Gastro-Esophageal Organic Disease Unit, IRRCS Azienda Universitaria-Ospedaliera di Bologna, 40138 Bologna, Italy
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Shyu TC, Wu CJ, Fu YC, Peng YC, Chuang TY, Kuo HC, Hsieh KS, Tai IH. Prevalence of antecedent Kawasaki disease in young adults with suspected acute coronary syndrome in high incidence cohort. Front Cardiovasc Med 2023; 10:1167771. [PMID: 37600029 PMCID: PMC10436480 DOI: 10.3389/fcvm.2023.1167771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Acute coronary syndrome (ACS) in early adulthood (<40 years old) may be associated with unrevealed diagnoses of Kawasaki disease (KD) in childhood. Daniels et al. showed that 5% of young adults with acute coronary syndrome might have antecedent Kawasaki disease in a cohort with Kawasaki disease incidence rates ranging from about 9 to 20 per 100,000 children under 5 years of age. However, there is no relevant research from the cohort with higher incidence rates (>80-100 per 100,000 children under 5 years of age) of Kawasaki disease. Methods We conducted a multicenter, retrospective study by reviewing medical records and angiographic data from two institutions (middle and southern Taiwan, respectively) of adults <40 years of age who underwent coronary angiography for clinically suspected acute coronary syndrome (2009-2019). Angiographic images were independently analyzed by three cardiologists who were blinded to the medical records. Demographic and laboratory data and risk factors of coronary artery disease were integrated to assess the likelihood of antecedent KD. Results All 323 young adults underwent coronary angiography, and 27 had coronary aneurysms. The patients' clinical and angiographic characteristics were evaluated, and 7.4% had aneurysms likely to be associated with KD. Most subjects were male (23/24), and their low-density lipoprotein (LDL) levels were significantly higher (p = 0.028) than those of subjects unlikely to have KD. Conclusion This study proposed that the cohort with higher Kawasaki disease incidence rates may have a higher prevalence of young adult ACS associated with antecedent KD. The importance of determining the clinical therapeutic significance of antecedent Kawasaki disease in young adult ACS warrants advanced research. Higher LDL levels may have a long-term cardiovascular impact in KD patients with persistent coronary aneurysms.
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Affiliation(s)
- Tsung-Cheng Shyu
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yun-Ching Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chin Peng
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzu-Yao Chuang
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Hsin Tai
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
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Visi G, Spina F, Del Duca F, Manetti AC, Maiese A, La Russa R, Frati P, Fineschi V. Autoptic Findings in Cases of Sudden Death Due to Kawasaki Disease. Diagnostics (Basel) 2023; 13:diagnostics13111831. [PMID: 37296682 DOI: 10.3390/diagnostics13111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Kawasaki disease (KD) is the second-most-common childhood vasculitis, and its etiology is still unknown today. Even though the acute illness is usually self-limiting, sometimes, it can generate complications, such as coronary artery aneurysms (CAA), acute myocardial infarction (AMI), heart failure, or arrhythmias, and can rarely cause sudden or unexpected deaths. We present a review of the literature, which collects autoptic and histopathological data relating to many of the cases of these deaths. On the basis of the titles and abstracts, we selected 54 scientific publications for a total of 117 cases. Among them, as expected, the majority of the deaths were due to AMI (41.03%), arrhythmia (8.55%), acute coronary syndrome (8.55%), and CAA rupture (11.97%), involving mostly 20-year-olds or younger individuls (69.23%). This is not surprising since the CAs are the most involved arteries. Gross autoptic and histopathological findings are reported in the paper. Our work revealed that, when compared with the incidence of KD, only a few cases suffered from sudden death, underwent an autoptic examination, and were then described in the literature. We suggest that researchers should perform autopsies to gain a better understanding of the molecular pathways involved in KD so as to propose further innovative therapeutic protocols or implement more appropriate prevention schemes.
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Affiliation(s)
- Giacomo Visi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Federica Spina
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alice Chiara Manetti
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
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Vasudeva R, Poku FA, Thommana M, Parmar G, Umscheid J, Parmar N, Koranteng CA, Singh A, Patel K, Yagnik P, Donda K, Bhatt P, Dapaah-Siakwan F. Trends and Resource Utilization in Kawasaki Disease Hospitalizations in the United States, 2008-2017. Hosp Pediatr 2022; 12:257-266. [PMID: 35106586 DOI: 10.1542/hpeds.2021-006142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To explore trends in hospitalization rate, resource use, and outcomes of Kawasaki Disease (KD) in children in the United States from 2008 to 2017. METHODS This was a retrospective, serial cross-sectional analysis of pediatric hospitalizations with International Classification of Disease diagnostic codes for KD in the National Inpatient Sample. Hospitalization rates per 100 000 populations were calculated and stratified by age group, gender, race, and US census region. Prevalence of coronary artery aneurysms (CAA) were expressed as proportions of KD hospitalizations. Resource use was defined in terms of length of stay and hospital cost. Cochran-Armitage and Jonckheere-Terpstra trend tests were used for categorical and continuous variables, respectively. P <.05 was considered significant. RESULTS A total of 43 028 pediatric hospitalizations identified with KD, yielding an overall hospitalization rate of 5.5 per 100 000 children. The overall KD hospitalization rate remained stable over the study period (P = .18). Although KD hospitalization rates differed by age group, gender, race, and census region, a significant increase was observed among Native Americans (P = .048). Rates of CAA among KD hospitalization increased from 2.4% to 6.8% (P = .04). Length of stay remained stable at 2 to 3 days, but inflation-adjusted hospital cost increased from $6819 in 2008 to $10 061 in 2017 (Ptrend < 0.001). CONCLUSIONS Hospitalization-associated costs and rates of CAA diagnostic codes among KD hospitalizations increased, despite a stable KD hospitalization rate between 2008 and 2017. These findings warrant further investigation and confirmation with databases with granular clinical information.
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Affiliation(s)
- Rhythm Vasudeva
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | | | - Mary Thommana
- K. J. Somaiya Medical College & Research Centre, Mumbai, India
| | - Garima Parmar
- Department of Pediatrics, Kasturba Medical College, Mangalore, India
| | - Jacob Umscheid
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York
| | | | | | - Kripa Patel
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Priyank Yagnik
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Keyur Donda
- Department of Pediatrics, University South Florida, Tampa, Florida
| | - Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
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