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Wang Y, Cao Y, Li Y, Zhu F, Yuan M, Xu J, Ma X, Li J. Development of an immunoinflammatory indicator-related dynamic nomogram based on machine learning for the prediction of intravenous immunoglobulin-resistant Kawasaki disease patients. Int Immunopharmacol 2024; 134:112194. [PMID: 38703570 DOI: 10.1016/j.intimp.2024.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Approximately 10-20% of Kawasaki disease (KD) patients suffer from intravenous immunoglobulin (IVIG) resistance, placing them at higher risk of developing coronary artery aneurysms. Therefore, we aimed to construct an IVIG resistance prediction tool for children with KD in Shanghai, China. METHODS Retrospective analysis was conducted on data from 1271 patients diagnosed with KD and the patients were randomly divided into a training set and a validation set in a 2:1 ratio. Machine learning algorithms were employed to identify important predictors associated with IVIG resistance and to build a predictive model. The best-performing model was used to construct a dynamic nomogram. Moreover, receiver operating characteristic curves, calibration plots, and decision-curve analysis were utilized to measure the discriminatory power, accuracy, and clinical utility of the nomogram. RESULTS Six variables were identified as important predictors, including C-reactive protein, neutrophil ratio, procalcitonin, CD3 ratio, CD19 count, and IgM level. A dynamic nomogram constructed with these factors was available at https://hktk.shinyapps.io/dynnomapp/. The nomogram demonstrated good diagnostic performance in the training and validation sets (area under the receiver operating characteristic curve = 0.816 and 0.800, respectively). Moreover, the calibration curves and decision curves analysis indicated that the nomogram showed good consistency between predicted and actual outcomes and had good clinical benefits. CONCLUSION A web-based dynamic nomogram for IVIG resistance was constructed with good predictive performance, which can be used as a practical approach for early screening to assist physicians in personalizing the treatment of KD patients in Shanghai.
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Affiliation(s)
- Yue Wang
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Yinyin Cao
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Yang Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Fenhua Zhu
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Meifen Yuan
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Jin Xu
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Xiaojing Ma
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Jian Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
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Tan JYC, Ng SY, Chan HK, Wong PM, Mohamed Zabidi H, Abu Hassan MR. Hibiscus score: Developing and validating a predictive tool for intravenous immunoglobulin treatment resistance in Malaysian children with Kawasaki disease. J Cardiol 2024:S0914-5087(24)00102-3. [PMID: 38852775 DOI: 10.1016/j.jjcc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Children with intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) are at higher risk of developing coronary artery (CA) aneurysm. Early identification of high-risk patients using a predictive tool would allow for earlier interventions to prevent cardiac complications. METHODS Children with KD who were admitted to five selected hospitals in Malaysia between 2008 and 2018 and received 2 g/kg of IVIG within 10 days from the onset of illness were included. Predictors of IVIG resistance in KD were determined using multiple logistic regression analysis. An optimal cut-off point was set using receiver operative characteristic curve and a final multiple logistic regression analysis was performed entering these cut-off points. A new scoring system was constructed. RESULTS A total of 276 patients were included. IVIG resistance occurred in 9.1 % of them. Total bilirubin [OR 7.37; 95 % CI (2.18, 24.83)], male sex [OR 0.34; 95 % CI (0.10, 1.19)], C-reactive protein (CRP) [OR 0.17; 95 % CI (0.02, 1.38)] and neutrophils [OR 0.25; 95 % CI (0.05, 1.21)] were found to be significant predictors for IVIG resistance. The findings led to the development of a new predictive tool called the Hibiscus score, which scored 1 point each for neutrophils ≥60 %, CRP ≥80 mg/L, and male sex, while total bilirubin ≥9.4 μmol/L scored 2 points. A cut-off point of ≥4 with this prediction score yielded a sensitivity of 78.9 % and specificity of 80.5 %, with area under the curve of 0.835 [95 % CI (0.752, 0.919)]. CA aneurysms occurred in 6.7 % of IVIG responders and 32 % of IVIG-resistant children (p < 0.001). CONCLUSION The findings suggest that the Hibiscus score has a higher predictive power than the existing scoring systems for IVIG resistance in children with KD in Malaysia. However, external validation is required to enable its use to guide treatment decisions.
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Affiliation(s)
- Jenny Yee Chen Tan
- Department of Pharmacy, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
| | - See Yee Ng
- Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Huan Keat Chan
- Clinical Research Center, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Pui Mun Wong
- Department of Pharmacy, Hospital Serdang, Selangor, Malaysia
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Guo Y, Yang L, Shao S, Zhang N, Hua Y, Zhou K, Ma F, Liu X. Coronary artery dilation in children with febrile illnesses other than Kawasaki disease: A case report and literature review. Heliyon 2023; 9:e21385. [PMID: 37954359 PMCID: PMC10637972 DOI: 10.1016/j.heliyon.2023.e21385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
Background Coronary artery dilation (CAD) had rarely been described as a cardiac complication of febrile disease other than Kawasaki disease (KD). There are rare cases complicated by CAD reported in patients with Mycoplasma pneumoniae (MP) infection. Case presentation A 6-year-old boy with severe Mycoplasma pneumoniae pneumonia (MPP) was transferred to our hospital due to significant respiratory distress on the 11th day from disease onset. Nadroparin, levofloxacin, and methylprednisolone followed by oral prednisone were aggressively prescribed. His clinical condition gradually achieved remission, and the drugs were withdrawn on the 27th day. Regrettably, the recurrent fever attacked him again in the absence of infection-toxic manifestations. Necrotizing pneumonia (NP) was found on chest CT. And echocardiography revealed right CAD (diameter, 3.40mm; z-score, 3.8), however, his clinical and laboratory findings did not meet the diagnostic criteria of KD. CAD was proposed to result from MP infection, and aspirin was prescribed. Encouragingly, the CAD regressed one week later (diameter, 2.50mm; z-score, 1.4). Additionally, the child defervesced seven days after the initiation of prednisone and Nadroparin treatment. The patient was ultimately discharged home on the 50th day. During follow-up, the child was uneventful with normal echocardiography and fully resolved chest CT lung lesions. Conclusions CAD can develop in patients with severe MP infection. Pediatricians should be alert to the possibility of CAD in patients with severe MP infection and recognize that CAD might also develop in febrile disease rather than KD.
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Affiliation(s)
- Yafei Guo
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lixia Yang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuran Shao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Nanjun Zhang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ma
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Chen J, Liao J, Xiang L, Zhang S, Yan Y. Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review. Front Immunol 2023; 14:1237670. [PMID: 37936712 PMCID: PMC10626541 DOI: 10.3389/fimmu.2023.1237670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Kawasaki disease (KD), an autoinflammatory disease primarily affecting young children, characterized by consisting of acute systemic vasculitis and coronary artery involvement in severe cases. Intravenous immunoglobulin gamma (IVIG) combined with aspirin therapy is the first-line regimen for the prevention of coronary aneurysms in the acute phase of KD. The etiology and pathogenesis of KD are unclear, but its incidence is increasing gradually, especially in the cases of IVIG-naïve KD and refractory KD. Conventional therapies for refractory KD have unsatisfactory results. At present, infliximab (IFX), a human-murine chimeric monoclonal antibody that specifically blocks tumor necrosis factor-α (TNF-α), has made great progress in the treatment of KD. This review revealed that IFX infusion (5 mg/kg) could effectively modulate fever, reduce inflammation, improve arthritis, diminish the number of plasma exchange, decrease hospitalizations, and prevent the progression of coronary artery lesions. The adverse effects of IFX administration included skin rash, arthritis, respiratory disease, infusion reaction, hepatomegaly, and vaccination-associated complications. But the incidence of these adverse effects is low. The clear optimal application protocol of the application of IFX for either initial combination therapy or salvage therapy in KD is still under investigation. In addition, there are no effective biomarkers to predict IFX resistance. Further multicenter trials with large sample size and long-term follow-up are still needed to validate the clinical efficacy and safety of IFX for IVIG-resistant KD or refractory KD.
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Affiliation(s)
- Jiaying Chen
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Jian Liao
- Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, China
| | - Lupeng Xiang
- Taizhou University Medical School, Taizhou, Zhejiang, China
| | - Shilong Zhang
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yajing Yan
- Health Management Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Suzuki T, Kawai S, Morihana E, Kawabe S, Iwata N, Saito K, Yoshikawa T, Yasuda K. Association of steroid administration with larger coronary artery abnormalities in patients with Kawasaki disease. Cardiol Young 2023; 33:1112-1116. [PMID: 35833216 DOI: 10.1017/s1047951122002104] [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: 11/07/2022]
Abstract
We sought to elucidate the risk profiles of patients with Kawasaki disease who developed coronary artery abnormalities through a retrospective analysis with special reference to steroid treatment. Demographics of the patients were obtained from medical records, and characteristics of the coronary artery abnormalities were evaluated by echocardiography and coronary angiography, which included number, location, size, and length of coronary artery abnormalities (we evaluated by cardiac catheterisation with the American Heart Association classification with segments). We divided the patients into two groups based on steroid use and compared their characteristics and the complications of coronary artery abnormalities and cardiac events. A total of 29 patients were diagnosed with coronary artery abnormalities by echocardiography and coronary angiography during the study period (24 male; median age, 24 months [range: 2-84 months]). Eighteen patients were treated with aspirin and intravenous immunoglobulin (63%, non-steroid group), whereas 11 received aspirin and intravenous immunoglobulin plus steroids (37%, steroid group). No significant differences were found in the number and location of coronary artery abnormalities between the steroid and non-steroid groups. However, the size and number of segments for coronary artery abnormalities were significantly larger and shorter, respectively, in the steroid group (z-score: non-steroid group 6.3 versus steroid group 8.7; p < 0.01). The coronary artery abnormality segments under steroid use were also shorter (non-steroid group versus steroid group, two segments versus one segment; p = 0.02). Coronary artery abnormality size was larger in patients who used steroids than that of non-steroids. This study showed that steroid use significantly affected coronary artery abnormality size in patients with Kawasaki disease. However, cardiac complications from coronary artery abnormalities and cardiac events were comparable between the steroid and non-steroid groups. Further prospective, multicentre studies are needed to confirm these findings.
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Affiliation(s)
- Takanori Suzuki
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Satoru Kawai
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Eiji Morihana
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shinji Kawabe
- Department of Infectious Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Naomi Iwata
- Department of Infectious Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Kazuyoshi Saito
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kazushi Yasuda
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
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Zahari N, Bah MNM, Sulieman MF, Choo HL. Intravenous immunoglobulin-resistant Kawasaki disease: Risk factors in children in a middle-income country. Ann Pediatr Cardiol 2023; 16:102-108. [PMID: 37767168 PMCID: PMC10522152 DOI: 10.4103/apc.apc_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background Identifying risk factors in patients with intravenous immunoglobulin (IVIG) resistance Kawasaki disease (KD) is vital in managing and preventing coronary artery aneurysms (CAAs). We aimed to study the risk factors for IVIG resistance KD in Malaysian children. Methods This retrospective observational study of children with KD was conducted at two tertiary hospitals in Malaysia from January 2014 to December 2019. Multivariable binary logistic regression was used to analyze the risk factors associated with IVIG resistance. Results A total of 174 patients, 118 males (67.8%) with a median age of 1.4-year-old (interquartile range: 0.1-12.1-year-old), were analyzed. Early (<5 days) and late (>10 days) IVIG treatments were observed in 14 (8.1%) and 19 (11.0%), respectively. Thirty-two patients (18.4%) had IVIG resistance. The independent factors associated with IVIG resistance were high white cell count, hypoalbuminemia, and extremities changes with an odd ratio of 4.7, 3.0, and 4.0, respectively. In addition, CAA was significantly higher in IVIG resistance compared to IVIG responder patients (57.5% [19/33] vs. 23.4% [33/141], P < 0.001). The sensitivity was high in Harada (93.8%) but low in Kobayashi and Egami (46.9% and 34.4%, respectively). The specificity was high with Egami (79.6%) but low in Harada and Kobayashi (22.5% and 64.1%, respectively). Conclusion Leukocytosis, hypoalbuminemia, and extremities changes were independent risk factors for IVIG resistance. The variation in sensitivity and specificity of the Japanese scoring makes it unsuitable for predicting IVIG resistance in Malaysian children.
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Affiliation(s)
- Norazah Zahari
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | | | - Hung Liang Choo
- Department of Pediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
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Furuta T, Yasudo H, Okada S, Ohnishi Y, Kawakami-Miyake A, Suzuki Y, Ohga S, Hasegawa S. Third-line therapies in patients with Kawasaki disease refractory to first- and second-line intravenous immunoglobulin therapy. World J Pediatr 2022; 18:781-785. [PMID: 35976528 DOI: 10.1007/s12519-022-00602-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Takashi Furuta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yuji Ohnishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Akiko Kawakami-Miyake
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
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Peña-Juárez A, Medina-Andrade MA, Olivares IER, Colín-Ortíz JL, Yamazaki-Nakashimada MA, Garrido-Garcia LM. Multiresistant Kawasaki Disease Complicated With Facial Nerve Palsy, Bilateral Giant Coronary Artery Aneurysms, and Stenosis of the Right Coronary Artery in an Infant. J Clin Rheumatol 2021; 27:S351-S354. [PMID: 33298814 DOI: 10.1097/rhu.0000000000001586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burns JC, Roberts SC, Tremoulet AH, He F, Printz BF, Ashouri N, Jain SS, Michalik DE, Sharma K, Truong DT, Wood JB, Kim KK, Jain S. Infliximab versus second intravenous immunoglobulin for treatment of resistant Kawasaki disease in the USA (KIDCARE): a randomised, multicentre comparative effectiveness trial. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:852-861. [PMID: 34715057 DOI: 10.1016/s2352-4642(21)00270-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease, 10-20% of patients have recrudescent fever as a sign of persistent inflammation and require additional treatment. We aimed to compare infliximab with a second infusion of IVIG for treatment of resistant Kawasaki disease. METHODS In this multicentre comparative effectiveness trial, patients (aged 4 weeks to 17 years) with IVIG resistant Kawasaki disease and fever at least 36 h after completion of their first IVIG infusion were recruited from 30 hospitals across the USA. Patients were randomly assigned (1:1) to second IVIG (2 g/kg over 8-12 h) or intravenous infliximab (10 mg/kg over 2 h without premedication), by using a randomly permuted block randomisation design with block size of two or four. Patients with fever 24 h to 7 days following completion of first study treatment crossed over to receive the other study treatment. The primary outcome measure was resolution of fever at 24 h after initiation of study treatment with no recurrence of fever attributed to Kawasaki disease within 7 days post-discharge. Secondary outcome measures included duration of fever from enrolment, duration of hospitalisation after randomisation, and changes in markers of inflammation and coronary artery Z score. Efficacy was analysed in participants who received treatment and had available outcome values. Safety was analysed in all randomised patients who did not withdraw consent. This clinical trial is registered with ClinicalTrials.gov, NCT03065244. FINDINGS Between March 1, 2017, and Aug 31, 2020, 105 patients were randomly assigned to treatment and 103 were included in the intention-to-treat population (54 in the infliximab group, 49 in the second IVIG group). Two patients randomised to infliximab did not receive allocated treatment. The primary outcome was met by 40 (77%) of 52 patients in the infliximab group and 25 (51%) of 49 patients in the second IVIG infusion group (odds ratio 0·31, 95% CI 0·13-0·73, p=0·0076). 31 patients with fever beyond 24 h received crossover treatment: nine (17%) in the infliximab group received second IVIG and 22 (45%) in second IVIG group received infliximab (p=0·0024). Three patients randomly assigned to infliximab and two to second IVIG with fever beyond 24h did not receive crossover treatment. Mean fever days from enrolment was 1·5 (SD 1·4) for the infliximab group and 2·5 (2·5) for the second IVIG group (p=0·014). Mean hospital stay was 3·2 days (2·1) for the infliximab group and 4·5 days (2·5) for the second IVIG group (p<0·001). There was no difference between treatment groups for markers of inflammation or coronary artery outcome. 24 (44%) of 54 patients in the infliximab group and 33 (67%) of 49 in the second IVIG group had at least one adverse event. A drop in haemoglobin concentration of at least 2g/dL was seen in 19 (33%) of 58 patients who received IVIG as either their first or second study treatment (three of whom required transfusion) and in three (7%) of 43 who received only infliximab (none required transfusion; p=0·0028). Haemolytic anaemia was the only serious adverse events deemed definitely or probably related to study treatment, and was reported in nine (15%) of 58 patients who received IVIG as either their first or second study treatment and none who received infliximab only. INTERPRETATION Infliximab is a safe, well tolerated, and effective treatment for patients with IVIG resistant Kawasaki disease, and results in shorter duration of fever, reduced need for additional therapy, less severe anaemia, and shorter hospitalisation compared with second IVIG infusion. FUNDING Patient Centered Outcomes Research Institute.
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Affiliation(s)
- Jane C Burns
- Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
| | - Samantha C Roberts
- Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Adriana H Tremoulet
- Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Feng He
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Beth F Printz
- Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | - Supriya S Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA; Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Kavita Sharma
- Children's Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dongngan T Truong
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - James B Wood
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA; Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Studying Clinical, Biologic and Echocardiography Criteria to Predict a Resistant Kawasaki Disease in Children. Pediatr Infect Dis J 2021; 40:710-714. [PMID: 34250971 DOI: 10.1097/inf.0000000000003144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resistant Kawasaki disease (KD) represents 10%-15% of KD patients and increases risk of coronary artery abnormalities (CAAs). Different scores exist to predict resistant KD but only in Japanese population, although a French team has recently proposed a new scoring system. The principal objective of this study is to establish criteria to predict resistant KD in our representative French population. The second objective is an attempt to develop a predictive score of resistant KD. METHODS We conducted a retrospective multicenter study including 2 universities and five secondary hospitals in Eastern France. Patients were included over a period from January 1, 2010 through December 31, 2019. Diagnosis of KD was recorded to the European Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) initiative criteria. RESULTS Two hundred two eligible patients had KD and 194 patients were analyzed: 160 sensitive KD and 34 (17.5%) resistant KD. In univariate model, serum sodium <133 mmol/L (odds ratio [OR] 2.97 [1.40-6.45]), hemoglobin level <110 g/L (OR 3.17 [1.46-7.34]), neutrophils >80% (OR 2.36 [1.03-5.25]), C reactive protein level >150 mg/L (OR 4.47 [2.07-10.19]), CAA (OR 3.85 [1.67-8.79]) or myocarditis (OR 6.98 [1.47-36.95]) at the diagnosis were statistically significant, but only serum sodium was an independent factor of resistant KD. CONCLUSION This study shows an association between resistant KD and biologic and echocardiography criteria, but only serum sodium is an independent predictive factor. A score to predict resistant KD could not yet be established.
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11
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James KE, Kalot MA, Husainat NM, Dua AB, Byram K, Springer JM, Lin YC, Turgunbaev M, Villa-Forte A, Gorelik M, Abril A, Langford C, Maz M, Chung SA, Mustafa RA. Kawasaki Disease: A Systematic Review and Meta-Analysis of Benefits and Harms of Common Treatments. ACR Open Rheumatol 2021; 3:671-683. [PMID: 34313406 PMCID: PMC8516108 DOI: 10.1002/acr2.11308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/06/2022] Open
Abstract
Objective Kawasaki disease (KD) is a self‐limited vasculitis affecting medium‐sized vessels with a predilection for the coronary arteries. Although treatment reduces the likelihood of developing of coronary artery aneurysms, 5% of patients still develop aneurysms despite treatment, making KD the leading cause of acquired heart disease in children in the United States. Consequently, there is a great deal of interest in optimizing treatment regimens, particularly for higher‐risk patients, to decrease morbidity. The aim of this systematic review is to support the development of the American College of Rheumatology/Vasculitis Foundation for the diagnosis and management of KD, focusing on the more complex scenarios in which rheumatologists may become involved, such as high‐risk and refractory disease. Methods Eighty‐nine articles were considered for full review in this systematic literature review to address 16 Population, Intervention, Comparison, and Outcome questions related to KD. Data were abstracted in hierarchical fashion. Randomized control trials (RCTs) were considered first; if none were identified or if they contained insufficient information, comparative observational studies were then viewed, followed by single‐arm observational studies/single arms from comparative studies. Only observational studies with more than 10 subjects with vasculitis were included. Results Eight RCTs and 28 observational studies that addressed the questions were identified. Two questions were addressed by RCTs, seven questions had at least some comparative observational studies, three questions were only addressed by single‐arm data, and four questions had no relevant studies. Conclusion This systematic review evaluates the benefits and harms of treatments for KD beyond first‐line therapy.
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Affiliation(s)
| | | | | | - Anisha B Dua
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin Byram
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Marat Turgunbaev
- Clinical Practice Guidelines, American College of Rheumatology, Atlanta, Georgia
| | | | | | - Andy Abril
- Columbia University Irving Medical Center, New York, New York
| | | | - Mehrdad Maz
- University of Kansas Medical Center, Kansas City, KS
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12
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Qin Q, Wang D, Xu L, Lan Y, Tong M. Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node-First Presentation of Kawasaki Disease by Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1371-1380. [PMID: 33006783 DOI: 10.1002/jum.15518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of our study was to evaluate the potential of cervical lymph node shear wave elastography (SWE) to quantify the lymph node stiffness (kilopascals) noninvasively among patients with lymph node-first presentation of Kawasaki disease (NFKD), patients with bacterial cervical lymphadenitis (BCL), and healthy children (HC). We further aimed to investigate the correlation of laboratory data and lymph node stiffness to provide a reference basis for the early diagnosis of NFKD. METHODS Lymph node stiffness measurements were prospectively performed in 47 patients with NFKD, 56 patients with BCL, and 56 HC using SWE. Cervical SWE was compared in the groups. Factors associated with increased cervical lymph node stiffness were studied. RESULTS The mean elasticity of the largest cervical lymph nodes was significantly higher in the BCL group than the NFKD and HC groups (mean elasticity ± SD, 16.37 ± 2.45, 12.22 ± 2.64, and 7.81 ± 1.67 kPa, respectively; P < .01), with a cutoff of 14.55 kPa (area under the curve, 0.885; sensitivity, 89%; and specificity, 76%). In patients with NFKD, interleukin 6 (standardized β = 0.363; P = .01), alanine aminotransferase (standardized β = 0.253; P = .03), aspartate aminotransaminase (standardized β = 0.536; P = .047), and total bilirubin (standardized β = 0.486; P < .01) values were correlated with increased largest cervical lymph node stiffness. CONCLUSIONS Cervical lymph node stiffness was different between NFKD and BCL. Shear wave elastography is a potential method to identify clinically distinguishable early NFKD.
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Affiliation(s)
- Qin Qin
- Lanzhou University Second Hospital, Lanzhou, China
| | - Dandan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Lili Xu
- Lanzhou University Second Hospital, Lanzhou, China
| | - Yuxia Lan
- Lanzhou University Second Hospital, Lanzhou, China
| | - Minghui Tong
- Lanzhou University Second Hospital, Lanzhou, China
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13
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Porritt RA, Chase Huizar C, Dick EJ, Kumar S, Escalona R, Gomez AC, Marek-Iannucci S, Noval Rivas M, Patterson J, Forsthuber TG, Arditi M, Gorelik M. Inhibition of IL-6 in the LCWE Mouse Model of Kawasaki Disease Inhibits Acute Phase Reactant Serum Amyloid A but Fails to Attenuate Vasculitis. Front Immunol 2021; 12:630196. [PMID: 33897686 PMCID: PMC8064710 DOI: 10.3389/fimmu.2021.630196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Objective Kawasaki disease (KD) is the most common cause of acquired pediatric heart disease in the developed world. 10% of KD patients are resistant to front-line therapy, and no interventions exist to address secondary complications such as myocardial fibrosis. We sought to identify proteins and pathways associated with disease and anti-IL-1 treatment in a mouse model of KD. Methods Vasculitis was induced via Lactobacillus casei cell wall extract (LCWE) injection in 5-week-old male mice. Groups of mice were injected with LCWE alone, LCWE and IL-1 receptor antagonist anakinra, or saline for controls. Upper heart tissue was assessed by quantitative mass spectrometry analysis. Expression and activation of STAT3 was assessed by immunohistochemistry, immunofluorescence and Western blot, and IL-6 expression by RNA-seq and ELISA. A STAT3 small molecular inhibitor and anti-IL-6R antibody were used to evaluate the role of STAT3 and IL-6 in disease development. Results STAT3 was highly expressed and phosphorylated in cardiac tissue of LCWE-injected mice, and reduced following anakinra treatment. Il6 and Stat3 gene expression was enhanced in abdominal aorta of LCWE-injected mice and reduced with Anakinra treatment. IL-6 serum levels were enhanced in LCWE-injected mice and normalized by anakinra. However, neither inhibition of STAT3 nor blockade of IL-6 altered disease development. Conclusion Proteomic analysis of cardiac tissues demonstrates differential protein expression between KD-like, control and anakinra treated cardiac tissue. STAT3 and IL-6 were highly upregulated with LCWE and normalized by anakinra treatment. However, both STAT3 and IL-6 were dispensable for disease development indicating they may be bystanders of inflammation.
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Affiliation(s)
- Rebecca A Porritt
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Carol Chase Huizar
- Department of Biology, University of Texas San Antonio, San Antonio, TX, United States
| | - Edward J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Shyamesh Kumar
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Renee Escalona
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Angela C Gomez
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Stefani Marek-Iannucci
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Magali Noval Rivas
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jean Patterson
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Thomas G Forsthuber
- Department of Biology, University of Texas San Antonio, San Antonio, TX, United States
| | - Moshe Arditi
- Departments of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Biomedical Sciences, Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mark Gorelik
- Department of Pediatric Allergy, Immunology and Rheumatology, Columbia University Medical Center, New York, NY, United States
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14
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Importance of Serum Ferritin Level for Early Diagnosis and Differentiation in Patients with Kawasaki Disease with Macrophage Activation Syndrome. CHILDREN-BASEL 2021; 8:children8040269. [PMID: 33807266 PMCID: PMC8065514 DOI: 10.3390/children8040269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate the utility of the serum ferritin level as an early screening test of Kawasaki disease with macrophage activation syndrome (KD-MAS). We analyzed the serum ferritin levels on the first day of admission and the clinical progress of patients diagnosed with complete or incomplete KD. Of the 158 patients, 5 were diagnosed with KD-MAS. Conjunctival injection was significantly more frequent in KD group (p = 0.035), although there were no significant differences in other clinical features. On the first day of admission, the serum ferritin level in the KD-MAS group was >500 ng/mL, which was higher than that in the KD group (p = 0.001). In the KD-MAS group, total bilirubin, triglyceride, and lactate dehydrogenase (LDH) were significantly higher, and erythrocyte sedimentation rate (ESR), total protein, albumin, and fibrinogen were significantly lower than the KD group (p < 0.05). Four patients were diagnosed with MAS within 7 days after admission, and 4 (80%) patients with KD-MAS survived. In conclusion, carrying out an early ferritin screening test is important in patients with principal clinical features that may suspect KD. We propose to include ferritin level in the primary laboratory test to differentiate between KD with and without MAS early.
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15
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Long-term Incidence of Kawasaki Disease in a North American Community: A Population-Based Study. Pediatr Cardiol 2021; 42:1033-1040. [PMID: 33712894 PMCID: PMC7954362 DOI: 10.1007/s00246-021-02577-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/25/2021] [Indexed: 11/03/2022]
Abstract
To assess the longitudinal incidence of Kawasaki disease (KD) within the well-defined predominantly White population of Olmsted County, MN. This retrospective cohort study used a population-based medical record linkage system and manual chart reviews to identify children with KD in Olmsted County, MN between January 1, 1979-December 31, 2016. Age- and gender-adjusted incidence rates were calculated using the 2010 U.S. White population. 124 children with KD were confirmed during the study period (median age 3.5, 61% male, 85% White, 9% Asian). The overall age- and gender-adjusted incidence rates for all ages and < 5 years old were 9.8 and 21.4 per 100,000 person-years, respectively. There was an overall increase in incidence up to 1994 followed by plateau, except among children between the ages of 1-5 years. There was also an overall increase in incidence among females compared to males. 24% of children had cardiac complications. While the overall incidence of KD in Olmsted County appears to be stable since 1994, the incidence of KD in subgroups of children 1-5 years old and females seems to have increased. Given the rising trends and one-quarter of children developing cardiac complications, further studies identifying factors driving these trends are warranted.
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16
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Matsuoka R, Furuno K, Nanishi E, Onoyama S, Nagata H, Yamamura K, Sugitani Y, Kuraoka A, Mizuno Y, Sagawa K, Honjo S, Hara T, Ohga S. Delayed Development of Coronary Artery Aneurysm in Patients with Kawasaki Disease Who Were Clinically Responsive to Immunoglobulin. J Pediatr 2020; 227:224-230.e3. [PMID: 32810506 DOI: 10.1016/j.jpeds.2020.08.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To clarify the frequency and characteristics of discrepant outcomes of intravenous immunoglobulin (IVIG) between fever and coronary artery aneurysms (CAAs) in patients with Kawasaki disease. STUDY DESIGN This study included 325 patients who responded to oral aspirin and IVIG alone. The main outcome was CAA 4 weeks after disease onset. CAA was defined as ≥2.5 of maximum z score (Zmax) representing the highest value of 4 coronary artery branches. Immunoglobulin dosage and sequential changes in Zmax were reviewed to investigate the effects on fever and timing of CAA development. Logistic regression analyses with receiver operating characteristic curves using clinical and laboratory variables including the initial Zmax were performed to identify predictors of CAA at 4 weeks. RESULTS CAAs were either persistent or appeared de novo 4 weeks after diagnosis in 13 of 325 patients who responded to a single or repeated IVIG. Four single-dose IVIG-responders developed CAA although they had pretreatment Zmax of <2.0. The 2 single-dose IVIG responders with the greatest pretreatment Zmax (>4.5) developed persistent CAA. Receiver operating characteristic analysis demonstrated Zmax of 2.57 as the cut-off for predicting CAA. Multivariable analyses identified >2.5 Zmax (OR 9.08, 95% CI 1.26-65.3, P = .028, 50% sensitivity, 91% specificity) as the sole risk factor for CAA at 4 weeks in single-dose IVIG responders. CONCLUSIONS Delayed development and persistence of CAA in single-dose IVIG responders indicate that some factors other than those responsible for systemic inflammation may contribute to vasculitis in CAA. Baseline Zmax 2.5 aids in predicting CAAs.
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Affiliation(s)
- Ryohei Matsuoka
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Furuno
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan; Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sagano Onoyama
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Sugitani
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ayako Kuraoka
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yumi Mizuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Toshiro Hara
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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17
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Roh DE, Kwon JE, Kim YH. Diagnosis and management of Kawasaki disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.7.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a common form of vasculitis in childhood. Among the recent trends in Kawasaki disease, it is notable that the prevalence rate is increasing, and the proportion of “incomplete” Kawasaki disease is also increasing. A delayed diagnosis with prolonged fever can cause complications, such as coronary artery aneurysm and decreased myocardial contractility. These complications might lead to significant morbidity and mortality. Kawasaki disease is diagnosed when the patient meets the principal criteria for clinical symptoms. Following the diagnostic criteria can prevent overdiagnosis but lead to missing of the incomplete form of the disease. Therefore, it is important to accurately understand Kawasaki disease. As the coronavirus disease 2019 (COVID-19) pandemic continues, concerns about a novel severe Kawasaki-like disease in children related to COVID-19 emerges. Indeed, there have been several reports of Kawasaki-like disease related to COVID-19 in children. Kawasaki disease is no longer rare and is often encountered at hospitals. This paper will provide useful and accurate information on Kawasaki disease.
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18
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Wang J, Li J, Ren Y, Shi H, Rong X, Zhang X, Shao Y, Wu R, Chu M, Qiu H. Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease. Cardiol Res Pract 2020; 2020:8743548. [PMID: 32274211 PMCID: PMC7125506 DOI: 10.1155/2020/8743548] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/06/2020] [Accepted: 01/25/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the association between the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT ratio, AAR) and intravenous immunoglobulin (IVIG) resistance, coronary artery lesions (CAL), and coronary artery aneurysms (CAA) in children with Kawasaki disease (KD). DESIGN We retrospectively studied 2678 children with KD and divided them into two groups: a low-AAR group and a high-AAR group with a median AAR of 1.13 as the cut-off point. The differences in laboratory data, clinical manifestations, and coronary artery damage rates were compared between the two groups. RESULTS The incidence of CAL was higher in the low-AAR group than in the high-AAR group at 2 and 3-4 weeks after illness onset (p < 0.001, respectively). The IVIG resistance rate was significantly higher in the low-AAR group than in the high-AAR group (29.94% vs 21.71%, p < 0.001). The levels of C-reactive protein, erythrocyte sedimentation rate, white blood cell count, bilirubin, fibrinogen, thrombin time, D-dimer, and brain natriuretic peptide were also significantly higher in the low-AAR group compared with the high-AAR group. The levels of albumin and IgG were significantly lower in the low-AAR group compared with those of the high-AAR group. The proportion of typical KD cases in the low-AAR group was significantly higher than that in the high-AAR group. Low-AAR correlated with the risk of coronary artery damage and IVIG resistance. CONCLUSION Children with KD who had low-AAR value were more likely to develop coronary artery damage and IVIG resistance. Low AAR is a risk factor for CAL, CAA, and IVIG resistance in KD.
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Affiliation(s)
- Jinxin Wang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jiawen Li
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yue Ren
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Hongying Shi
- Department of Preventive Medicine, School of Public Health and Management, WenZhou Medical University, Wenzhou 325035, Zhejiang Province, China
| | - Xing Rong
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xuting Zhang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yiping Shao
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Rongzhou Wu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Huixian Qiu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
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Piram M, Darce Bello M, Tellier S, Di Filippo S, Boralevi F, Madhi F, Meinzer U, Cimaz R, Piedvache C, Koné-Paut I. Defining the risk of first intravenous immunoglobulin unresponsiveness in non-Asian patients with Kawasaki disease. Sci Rep 2020; 10:3125. [PMID: 32080307 PMCID: PMC7033244 DOI: 10.1038/s41598-020-59972-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
About 10–20% of patients with Kawasaki disease (KD) are unresponsive to intravenous immunoglobulin (IVIg) and are at increased risk of coronary artery abnormalities (CAAs). Early identification is critical to initiate aggressive therapies, but available scoring systems lack sensitivity in non-Japanese populations. We investigated the accuracy of 3 Japanese scoring systems and studied factors associated with IVIg unresponsiveness in a large multiethnic French population of children with KD to build a new scoring system. Children admitted for KD between 2011–2014 in 65 centers were enrolled. Factors associated with second line-treatment; i.e. unresponsiveness to initial IVIg treatment, were analyzed by multivariate regression analysis. The performance of our score and the Kobayashi, Egami and Sano scores were compared in our population and in ethnic subgroups. Overall, 465 children were reported by 84 physicians; 425 were classified with KD (55% European Caucasian, 12% North African/Middle Eastern, 10% African/Afro-Caribbean, 3% Asian and 11% mixed). Eighty patients (23%) needed second-line treatment. Japanese scores had poor performance in our whole population (sensitivity 14–61%). On multivariate regression analysis, predictors of secondary treatment after initial IVIG were hepatomegaly, ALT level ≥30 IU/L, lymphocyte count <2400/mm3 and time to treatment <5 days. The best sensitivity (77%) and specificity (60%) of this model was with 1 point per variable and cut-off ≥2 points. The sensitivity remained good in our 3 main ethnic subgroups (74–88%). We identified predictors of IVIg resistance and built a new score with good sensitivity and acceptable specificity in a non-Asian population.
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Affiliation(s)
- Maryam Piram
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France. .,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France.
| | - Martha Darce Bello
- AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
| | - Stéphanie Tellier
- CHU de de Toulouse, Paediatric Rheumatology, Nephrology and Internal medicine, Toulouse, France
| | | | | | | | - Ulrich Meinzer
- APHP, CHU Robert Debré, Paediatrics,Paediatric Internal Medicine,Rheumatology and Infectious Diseases, RAISE, Paris, France
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Celine Piedvache
- APHP, CHU de Bicêtre, Clinical Research Unit, Le Kremlin Bicêtre, France
| | - Isabelle Koné-Paut
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France.,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
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20
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Liu G, Wang S, Du Z. Risk Factors of Intravenous Immunoglobulin Resistance in Children With Kawasaki Disease: A Meta-Analysis of Case-Control Studies. Front Pediatr 2020; 8:187. [PMID: 32373568 PMCID: PMC7186309 DOI: 10.3389/fped.2020.00187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
Previous studies have shown that children with Kawasaki disease (KD) who fail to respond to intravenous immunoglobulin (IVIG) therapy are at higher risk of developing coronary artery lesions (CALs). We aimed to conduct a meta-analysis to uncover the risk factors associated with IVIG resistance in children with KD. PubMed, Embase, and Cochrane Library databases were searched up to 31st October 2019, and 23 case-control studies were finally eligible, enrolling 2,053 patients of IVIG resistance and 16,635 patients of IVIG sensitivity. Potential factors were comprehensively analyzed by using stata15 software with a standard meta-analysis procedure and consequently found that in addition to patients with polymorphous rash or swelling of extremities symptoms had a tendency to be non-responders, IVIG resistance was more likely to occur in patients with severe anemia, hypoalbuminemia, decreased baseline platelet count, and elevated levels of erythrocyte sedimentation rate (ESR), total bilirubin, alanine aminotransferase (ALT) and neutrophils percentage. Particularly, male sex, hyponatraemia, increased aspartate aminotransferase (AST), and C-reactive protein (CRP) were confirmed as the risk factors favor IVIG resistance in Mongoloids from Asia countries, but not in Caucasians from non-Asia regions. In summary, we report several risk factors relevant to IVIG resistance in children with KD, which may provide guidance for the prediction of IVIG resistance. But a proposing of an optimal prediction system with high specificity and sensitivity needs further studies because of confounding factors.
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Affiliation(s)
- Gengying Liu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shunyu Wang
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhongdong Du
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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21
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Kuniyoshi Y, Tokutake H, Takahashi N, Kamura A, Yasuda S, Tashiro M. Comparison of Machine Learning Models for Prediction of Initial Intravenous Immunoglobulin Resistance in Children With Kawasaki Disease. Front Pediatr 2020; 8:570834. [PMID: 33344380 PMCID: PMC7744372 DOI: 10.3389/fped.2020.570834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
We constructed an optimal machine learning (ML) method for predicting intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD) using commonly available clinical and laboratory variables. We retrospectively collected 98 clinical records of hospitalized children with KD (2-109 months of age). We found that 20 (20%) children were resistant to initial IVIG therapy. We trained three ML techniques, including logistic regression, linear support vector machine, and eXtreme gradient boosting with 10 variables against IVIG resistance. Moreover, we estimated the predictive performance based on nested 5-fold cross-validation (CV). We also selected variables using the recursive feature elimination method and performed the nested 5-fold CV with selected variables in a similar manner. We compared ML models with the existing system regardless of their predictive performance. Results of the area under the receiver operator characteristic curve were in the range of 0.58-0.60 in the all-variable model and 0.60-0.75 in the select model. The specificities were more than 0.90 and higher than those in existing scoring systems, but the sensitivities were lower. Three ML models based on demographics and routine laboratory variables did not provide reliable performance. This is possibly the first study that has attempted to establish a better predictive model. Additional biomarkers are probably needed to generate an effective prediction model.
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Affiliation(s)
- Yasutaka Kuniyoshi
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Haruka Tokutake
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Natsuki Takahashi
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Azusa Kamura
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Sumie Yasuda
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Makoto Tashiro
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
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22
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Hashimoto Y, Fukazawa R, Nagi-Miura N, Ohno N, Suzuki N, Katsube Y, Kamisago M, Akao M, Watanabe M, Hashimoto K, Tsuno K, Matsui R, Itoh Y. Interleukin-1beta Inhibition Attenuates Vasculitis in a Mouse Model of Kawasaki Disease. J NIPPON MED SCH 2019; 86:108-116. [PMID: 31130561 DOI: 10.1272/jnms.jnms.2019_86-206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Kawasaki disease (KD), a systemic vasculitis, is suspected to be related to abnormalities in innate immunity. Based on the important role of IL-1 signaling in innate immunity, we investigated the effects of an anti-IL-1β antibody using a Candida albicans water-soluble fraction (CAWS)-induced mouse model of KD. METHODS CAWS (0.5 mg/mouse) was injected intraperitoneally into 5-week-old DBA/2 mice on five consecutive days. An anti-Murine IL-1β antibody (01BSUR) was administered at various doses (2.5, 5.0, and 10.0 mg/kg) and time points (2 days before, same day, and 2, 5, 7, and 14 days after CAWS administration). After 4 weeks, vasculitis in the aortic root was investigated histologically. Cytokines including IL-1β, -6, -10, and TNF-α were also measured. RESULTS Groups administered 01BSUR at all doses showed a significant reduction in the area of vasculitis. In addition, 01BSUR inhibited vasculitis until 7 days after CAWS administration. In the analysis of various time points, the level of IL-6 was lower in all groups compared to the CAWS only group, but the levels of IL-1β, TNFα, and IL-10 were lower when 01BSUR was administered before CAWS. On the other hand, TNFα and IL-10 levels were restored when 01BSUR was administered after CAWS, suggesting that 01BSUR may have additional effects beyond blocking IL-1β signaling. CONCLUSIONS The anti-IL-1β antibody significantly attenuated CAWS-induced vasculitis. The mechanism of inhibiting vasculitis is thought to include inhibition of the IL-1β pathway and additional effects beyond blocking IL-1β signaling.
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Affiliation(s)
| | | | - Noriko Nagi-Miura
- Laboratory for Immunopharmacology of Microbial Products, Tokyo University of Pharmacy and Life Sciences
| | - Naohito Ohno
- Laboratory for Immunopharmacology of Microbial Products, Tokyo University of Pharmacy and Life Sciences
| | | | | | | | - Miharu Akao
- Department of Pediatrics, Nippon Medical School
| | | | | | - Kanae Tsuno
- Department of Pediatrics, Nippon Medical School
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23
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Duignan S, Doyle SL, McMahon CJ. Refractory Kawasaki disease: diagnostic and management challenges. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2019; 10:131-139. [PMID: 31802968 PMCID: PMC6826175 DOI: 10.2147/phmt.s165935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/23/2019] [Indexed: 01/27/2023]
Abstract
Kawasaki disease (KD), an acute, self-limiting, medium-sized arterial vasculitis, is now the most common cause of acquired heart disease in childhood in the developed world. In this review, we discuss the diagnosis of KD, predicting resistance to traditional therapy and treatment options in refractory or high-risk disease. We also highlight ongoing clinical trials and other potential avenues of research which may prove beneficial in managing children, especially those with resistant KD.
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Affiliation(s)
- Sophie Duignan
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Sarah L Doyle
- Department of Immunology, National Children's Research Centre, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Dublin 12, Ireland.,Department of Immunology, National Children's Research Centre, Dublin, Ireland
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24
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Makino N, Nakamura Y, Yashiro M, Kosami K, Matsubara Y, Ae R, Aoyama Y, Yanagawa H. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016. Pediatr Int 2019; 61:397-403. [PMID: 30786118 DOI: 10.1111/ped.13809] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/06/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 50 years have passed since Kawasaki disease (KD) was first reported. The KD nationwide survey began in 1970. Although >360 000 cases have already been reported in Japan, the cause is still unknown. In Japan, the number of patients and incidence rate of KD has continued to increase. It is necessary to examine the trend of the occurrence in the surveillance of KD. METHODS The nationwide survey of patient incidence in 2015 and 2016 was conducted in 2017, as the 24th nationwide survey of KD. A questionnaire was sent to pediatric departments in hospitals with >100 beds and specialized pediatric hospitals, and was responded to by the attending pediatricians. RESULTS The total number of patients in 2 years was 31 595, and the sex ratio (male/female) was 1.34. The incidence rate (/100 000 children aged 0-4 years/year) was 330.2 (371.2 in boys, 287.3 in girls) in 2015, and 309.0 (343.2 in boys, 273.2 in girls) in 2016. The number of patients by month peaked in January. The age-specific incidence rate according to sex was highest in children between 9 and 11 months of age, after which the incidence rate gradually decreased with advancing age. CONCLUSIONS We summarize the most recent nationwide survey of KD and consider the change in the epidemiologic picture.
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Affiliation(s)
- Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuri Matsubara
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yasuko Aoyama
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroshi Yanagawa
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
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25
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Roberts SC, Jain S, Tremoulet AH, Kim KK, Burns JC, Anand V, Anderson M, Ang J, Ansusinha E, Arditi M, Ashouri N, Bartlett A, Chatterjee A, DeBiasi R, Dekker C, DeZure C, Didion L, Dominguez S, El Feghaly R, Erdem G, Halasa N, Harahsheh A, Jackson MA, Jaggi P, Jain S, Jone PN, Kaushik N, Kurio G, Lillian A, Lloyd D, Manaloor J, McNelis A, Michalik DE, Newburger J, Newcomer C, Perkins T, Portman M, Romero J, Ronis T, Rowley A, Schneider K, Schuster J, Tejtel SKS, Sharma K, Simonsen K, Szmuszkovicz J, Truong D, Wood J, Yeh S. The Kawasaki Disease Comparative Effectiveness (KIDCARE) trial: A phase III, randomized trial of second intravenous immunoglobulin versus infliximab for resistant Kawasaki disease. Contemp Clin Trials 2019; 79:98-103. [PMID: 30840903 DOI: 10.1016/j.cct.2019.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease (KD), the most common cause of acquired heart disease in children, 10-20% of patients are IVIG-resistant and require additional therapy. This group has an increased risk of coronary artery aneurysms (CAA) and there has been no adequately powered, randomized clinical trial in a multi-ethnic population to determine the optimal therapy for IVIG-resistant patients. OBJECTIVES The primary outcome is duration of fever in IVIG-resistant patients randomized to treatment with either infliximab or a second IVIG infusion. Secondary outcomes include comparison of inflammatory markers, duration of hospitalization, and coronary artery outcome. An exploratory aim records parent-reported outcomes including signs, symptoms and treatment experience. METHODS The KIDCARE trial is a 30-site randomized Phase III comparative effectiveness trial in KD patients with fever ≥36 h after the completion of their first IVIG treatment. Eligible patients will be randomized to receive either a second dose of IVIG (2 g/kg) or infliximab (10 mg/kg). Subjects with persistent or recrudescent fever at 24 h following completion of the first study treatment will cross-over to the other treatment arm. Subjects will exit the study after their first outpatient visit (5-18 days following last study treatment). The parent-reported outcomes, collected daily during hospitalization and at home, will be compared by study arm. CONCLUSION This trial will contribute to the management of IVIG-resistant patients by establishing the relative efficacy of a second dose of IVIG compared to infliximab and will provide data regarding the patient/parent experience of these treatments.
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Affiliation(s)
- Samantha C Roberts
- Rady Children's Hospital, 7910 Frost St Suite 300, San Diego, CA, 92123, United States.
| | - Sonia Jain
- University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States.
| | - Adriana H Tremoulet
- University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States; University of California Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, United States.
| | - Katherine K Kim
- University of California Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Sacramento, CA 95817, United States.
| | - Jane C Burns
- Rady Children's Hospital, 7910 Frost St Suite 300, San Diego, CA, 92123, United States; University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States.
| | - Vikram Anand
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, West Hollywood, CA, 90048, United States
| | - Marsha Anderson
- Children's Hospital Colorado, 13123 East 16th Avenue, B100, Aurora, CO, 80045, United States
| | - Jocelyn Ang
- Children's Hospital of Michigan, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, United States
| | - Emily Ansusinha
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States of America
| | - Moshe Arditi
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, West Hollywood, CA, 90048, United States of America
| | - Negar Ashouri
- Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, United States
| | - Allison Bartlett
- The University of Chicago, Department of Pediatrics, 5841 South Maryland Avenue, MC6054, Chicago, IL, 60637, United States
| | - Archana Chatterjee
- University of South Dakota, Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, United States
| | - Roberta DeBiasi
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Cornelia Dekker
- Stanford School of Medicine, 300 Pasteur Drive, Room H313, Stanford, CA, 94305-5208, United States
| | - Chandani DeZure
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Lisa Didion
- Batson Children's Hospital, 2500 North State Street, Jackson, MS, 39216, United States
| | - Samuel Dominguez
- Children's Hospital Colorado, 13123 East 16th Avenue, B100, Aurora, CO, 80045, United States
| | - Rana El Feghaly
- Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, United States
| | - Guliz Erdem
- Nationwide Children's Hospital, 700 Children's Drive Suite T6B, Columbus, OH 43205, United States
| | - Natasha Halasa
- Vanderbilt School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, United States
| | - Ashraf Harahsheh
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Mary Anne Jackson
- Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, United States
| | - Preeti Jaggi
- Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - Supriya Jain
- Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College (NYMC), 100 Woods Road, Valhalla, NY, 10595, United States
| | - Pei-Ni Jone
- Children's Hospital Colorado, 13123 East 16th Avenue, B100, Aurora, CO, 80045, United States
| | - Neeru Kaushik
- UCSF Benioff Children's Hospital-Oakland, 747 52nd street, Oakland, CA, 94609, United States
| | - Gregory Kurio
- UCSF Benioff Children's Hospital-Oakland, 747 52nd street, Oakland, CA, 94609, United States
| | | | - David Lloyd
- Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - John Manaloor
- Indiana University School of Medicine, 705 Riley Hospital Dr, RI 3032, Indianapolis, IN, 46202, United States
| | - Amy McNelis
- UCSF Benioff Children's Hospital-San Francisco, 1691Mar West St, Tiburon, CA 94920, United States
| | - David E Michalik
- Miller Children's Hospital, Long Beach, 2801 Atlantic Avenue, Long Beach, CA, 90806, United States
| | - Jane Newburger
- Children's Hospital Boston, 300 Longwood Ave., Boston, MA, 02115, United States
| | - Charles Newcomer
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, A2-383 MDCC, Los Angeles, CA, 90095, United States
| | - Tiffany Perkins
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Michael Portman
- Seattle Children's, 4800 Sand Point Way NE, Seattle, WA, 98105, United States
| | - Jose Romero
- Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202-3591, United States
| | - Tova Ronis
- Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Anne Rowley
- The Ann & Robert H. Lurie Children's Hospital of Chicago, 310 E Superior Street, Morton 4-685B, Chicago, IL, 60611, United States
| | - Kathryn Schneider
- Batson Children's Hospital, 2500 North State Street, Jackson, MS, 39216, United States
| | - Jennifer Schuster
- Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, United States
| | - S Kristen Sexson Tejtel
- Texas Children's Hospital, 6621 Fannin St., MC-19345-C, Houston, TX, 77030, United States of America
| | - Kavita Sharma
- Children's Health, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX 75235, United States
| | - Kari Simonsen
- University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, NE 68198-2162, United States
| | - Jacqueline Szmuszkovicz
- Children's Hospital Los Angeles, Division of Cardiology, 4650 Sunset Blvd., Los Angeles, CA, 90027, United States
| | - Dongngan Truong
- University of Utah Health Care, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, United States
| | - James Wood
- Indiana University School of Medicine, 705 Riley Hospital Dr, RI 3032, Indianapolis, IN, 46202, United States
| | - Sylvia Yeh
- Harbor-UCLA Medical Center, 1124 W. Carson St., Torrance, CA, 90509, United States
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26
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Song MS. Predictors and management of intravenous immunoglobulin-resistant Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2019; 62:119-123. [PMID: 30999718 PMCID: PMC6477551 DOI: 10.3345/kjp.2019.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023]
Abstract
Kawasaki disease (KD) is a systemic vasculitis that mainly affects younger children. Intravenous immunoglobulin (IVIG) resistant cases are at increasing risk for coronary artery complications. The strategy on prediction of potential nonresponders and treatment of IVIG-resistant patients is now controversial. In this review the definition and predictors of IVIG-resistant KD and current evidence to guide management are discussed.
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Affiliation(s)
- Min Seob Song
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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27
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Yang S, Song R, Zhang J, Li X, Li C. Predictive tool for intravenous immunoglobulin resistance of Kawasaki disease in Beijing. Arch Dis Child 2019; 104:262-267. [PMID: 30026252 DOI: 10.1136/archdischild-2017-314512] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To construct a predictive tool for the efficacy of intravenous immunoglobulin (IVIG) therapy in children with Kawasaki disease (KD) in Beijing, China. DESIGN This was a cohort study. Data set (including clinical profiles and laboratory findings) of children with KD diagnosed between 1 January 2010 and 31 December 2015 was used to analyse the risk factors and construct a scoring system. Data set of children with KD diagnosed between 1 January 2016 and 1 December 2016 was used to validate this model. SETTING Children's Hospital Capital Institute of Pediatrics and Beijing Children's Hospital. PATIENTS 2102 children diagnosed with KD. INTERVENTIONS No. MAIN OUTCOME MEASURES Responsiveness to IVIG. RESULTS The predictive tool included C reactive protein ≥90 mg/L (3 points), neutrophil percentage ≥70% (2.5 points), sodium ion concentration <135 mmol/L (3 points), albumin <35 g/L (2.5 points) and total bilirubin >20 μmol/L (5 points), which generated an area under the the receiver operating characteristic curve of 0.77 (95% CI 0.71 to 0.82) for the internal validation data set, and 0.69 (95% CI 0.58 to 0.81) and 0.63 (95% CI 0.53 to 0.72) for two external validation data sets, respectively. If a total of ≥6 points were considered high-risk for IVIG resistance, sensitivity and specificity were 56% and 79% in the internal verification, and the predictive ability was similar in the external validation. CONCLUSIONS The predictive tool is helpful in early screening of high-risk IVIG resistance of KD in the Beijing area. Consequently, it will guide the clinician in selecting appropriate individualised regimens for the initial treatment of this disease, which is important for the prevention of coronary complications.
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Affiliation(s)
- Shuai Yang
- Department of Cardiovascular Diseases, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Ruixia Song
- Department of Cardiovascular Diseases, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Junmei Zhang
- Department of Rheumatology and Immunology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Li
- Department of Cardiovascular Diseases, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Caifeng Li
- Department of Rheumatology and Immunology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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28
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Procalcitonin levels predicting the infliximab response of immunoglobulin resistant Kawasaki disease. Cytokine 2019; 114:26-31. [DOI: 10.1016/j.cyto.2018.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/25/2018] [Indexed: 12/24/2022]
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29
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Skochko SM, Jain S, Sun X, Sivilay N, Kanegaye JT, Pancheri J, Shimizu C, Sheets R, Tremoulet AH, Burns JC. Kawasaki Disease Outcomes and Response to Therapy in a Multiethnic Community: A 10-Year Experience. J Pediatr 2018; 203:408-415.e3. [PMID: 30268398 DOI: 10.1016/j.jpeds.2018.07.090] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/02/2018] [Accepted: 07/26/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe the epidemiology, response to therapy, and outcomes of Kawasaki disease in a multiethnic community with a large Hispanic and Asian population. STUDY DESIGN We analyzed prospectively collected data from 788 unselected patients with Kawasaki disease diagnosed and treated at a single medical center over a 10-year period. RESULTS The average incidence of Kawasaki disease in children <5 years in San Diego County over the 10 years from 2006 to 2015 was 25 per 100 000 children, with the greatest incidence (50 per 100 000) for Asian/Pacific Islanders. Compared with other race/ethnicities, Asian/Pacific Islander patients with Kawasaki disease were younger, were diagnosed earlier in the course of their fever, had higher levels of inflammatory markers, and were more likely to develop aneurysms. There was no difference across race/ethnicity groups in response to intravenous immunoglobulin therapy. Filipino children had the highest recurrence rates (9.1%; 95% CI, 3.0%-22.6%) and 12 of 788 patients (1.5%) had a first- or second-degree relative with a history of Kawasaki disease. After correcting for age of onset, sex, and illness day at diagnosis, Asian/Pacific Islander children had an increased risk of developing aneurysms (aOR, 2.37; 95% CI, 1.37-4.11; P = .002). Overall, 180 of 788 patients (22.8%) had a maximal Z score of 2.5-10.0 and 14 of the 788 patients (1.8%) had a maximal Z score ≥10.0 despite 84% of these patients being treated within 10 days of fever onset. CONCLUSIONS Our data provide new insights into the natural history of treated Kawasaki disease in a multiethnic population. Patient race/ethnicity influenced susceptibility to Kawasaki disease, timing of diagnosis, coronary artery outcome, and recurrence rates.
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Affiliation(s)
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Nipha Sivilay
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - John T Kanegaye
- Rady Children's Hospital San Diego, San Diego, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | | | - Chisato Shimizu
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Robert Sheets
- Rady Children's Hospital San Diego, San Diego, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Adriana H Tremoulet
- Rady Children's Hospital San Diego, San Diego, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Jane C Burns
- Rady Children's Hospital San Diego, San Diego, CA; Department of Pediatrics, University of California, San Diego, La Jolla, CA.
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30
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Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:855-862. [DOI: 10.1016/s2352-4642(18)30293-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022]
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31
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Hur G, Song MS, Sohn S, Lee HD, Kim GB, Cho HJ, Yoon KL, Joo CU, Hyun MC, Kim CH. Infliximab Treatment for Intravenous Immunoglobulin-resistant Kawasaki Disease: a Multicenter Study in Korea. Korean Circ J 2018; 49:183-191. [PMID: 30468032 PMCID: PMC6351283 DOI: 10.4070/kcj.2018.0214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives We investigated the status of infliximab use in intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients and the incidence of coronary artery aneurysms (CAAs) according to treatment regimens. Methods Between March 2010 and February 2017, 16 hospitals participated in this study. A total of 102 (32.3±19.9 months, 72 males) who received infliximab at any time after first IVIG treatment failure were enrolled. Data were retrospectively collected using a questionnaire. Results Subjects were divided into two groups according to the timing of infliximab administration. Early treatment (group 1) had shorter fever duration (10.5±4.4 days) until infliximab infusion than that in late treatment (group 2) (16.4±4.5 days; p<0.001). We investigated the response rate to infliximab and the incidence of significant CAA (z-score >5). Overall response rate to infliximab was 89/102 (87.3%) and the incidence of significant CAA was lower in group 1 than in group 2 (1/42 [2.4%] vs. 17/60 [28.3%], p<0.001). Conclusions This study suggests that the early administration of infliximab may reduce the incidence of significant CAA in patients with IVIG-resistant KD. However, further prospective randomized studies with larger sample sizes are required.
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Affiliation(s)
- Gyu Hur
- Department of Pediatrics, Inje University, Haeundae Paik Hospital, Busan, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University, Haeundae Paik Hospital, Busan, Korea.
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Busan National University, Children's Hospital, Busan, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University, Children's Hospital, Gwangju, Korea
| | - Kyung Lim Yoon
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Chan Uhng Joo
- Department of Pediatrics, Chonbuk National University Medical School, Children's Hospital, Cheonju, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Chul Ho Kim
- Department of Pediatrics, Inje University, Busan Paik Hospital, Busan, Korea
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Fabi M, Corinaldesi E, Pierantoni L, Mazzoni E, Landini C, Bigucci B, Ancora G, Malaigia L, Bodnar T, Di Fazzio G, Lami F, Valletta E, Cicero C, Biasucci G, Iughetti L, Marchetti F, Sogno Valin P, Amarri S, Brusa S, Sprocati M, Maggiore G, Dormi A, Lanzoni P, Donti A, Lanari M. Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease? PLoS One 2018; 13:e0202658. [PMID: 30180185 PMCID: PMC6122791 DOI: 10.1371/journal.pone.0202658] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease. Objective To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. Methods Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases. Results 302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009). Conclusions This is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population. Clinical trial registration 8/20014/O/OssN.
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Affiliation(s)
- Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- * E-mail:
| | | | - Luca Pierantoni
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Mazzoni
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | - Chiara Landini
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | | | - Gina Ancora
- Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Laura Malaigia
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Tetyana Bodnar
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgia Di Fazzio
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Francesca Lami
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B.Morgagni–L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Cristina Cicero
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Giacomo Biasucci
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Lorenzo Iughetti
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Sergio Amarri
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Sandra Brusa
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Monica Sprocati
- Department of Pediatrics, Arcispedale Sant’Anna, Ferrara, Italy
| | | | - Ada Dormi
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Paolo Lanzoni
- Department of Pediatrics, Ramazzini Hospital, Carpi, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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Yang TJ, Lin MT, Lu CY, Chen JM, Lee PI, Huang LM, Wu MH, Chang LY. The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:321-331. [DOI: 10.1016/j.jmii.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 01/28/2023]
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Shin J, Lee H, Eun L. Verification of Current Risk Scores for Kawasaki Disease in Korean Children. J Korean Med Sci 2017; 32:1991-1996. [PMID: 29115081 PMCID: PMC5680498 DOI: 10.3346/jkms.2017.32.12.1991] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/15/2017] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to evaluate and assess the compatibility of current risk scoring systems from Japan that were developed to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). The authors previously investigated another prediction model for patients with refractory KD in Korea. A retrospective study involving 350 patients with KD who were admitted between January 2014 and December 2015 was performed. Patients younger than 2 years were excluded for the propensity score matching in this study. Patients were classified into IVIG responders and IVIG resistance groups. The well-known Harada, Kobayashi, and Egami risk scores were calculated for each patient, and the proportion of high-risk patients was compared between the two groups for each risk score. Logistic regression analysis revealed that platelets, C-reactive protein (CRP) levels, and aspartate aminotransferase levels were independent predictors of IVIG resistance. Multivariate analysis suggested that platelets and CRP were risk factors. Risk-scoring systems from Japan have good specificity but low sensitivity. Among the three risk scoring systems, the Kobayashi risk score demonstrated significant differences between the IVIG resistance and IVIG responder groups in Korean patients with KD. It is very important to identify IVIG-resistant patients to protect them from ongoing coronary arterial lesion(s); therefore, early prediction and timely optimal additional treatment is of significant benefit. It would be helpful to construct a highly sensitive, exclusive scoring system for Korean patients with KD.
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Affiliation(s)
- Jaeeun Shin
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Heeyoung Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Lucy Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
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Takeshita S, Kanai T, Kawamura Y, Yoshida Y, Nonoyama S. A comparison of the predictive validity of the combination of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and other risk scoring systems for intravenous immunoglobulin (ivig)-resistance in Kawasaki disease. PLoS One 2017; 12:e0176957. [PMID: 28542183 PMCID: PMC5441585 DOI: 10.1371/journal.pone.0176957] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We recently reported that the combination of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) is a novel and useful predictor of intravenous immunoglobulin (IVIG)-resistance in Kawasaki disease (KD). In the present study, to evaluate the effectiveness of the new risk score, we compared its predictive validity to that of previously reported risk scores. MATERIALS AND METHODS The laboratory records of 437 patients with KD before IVIG therapy were retrospectively analyzed, and the IVIG-responsive (n = 344) and IVIG-resistant (n = 93) patients were compared. The validity of the new score (the combination of NLR≥3.83 and PLR≥150) for predicting IVIG resistance in KD was compared to that of the Kobayashi, Egami and Sano risk scores. RESULTS The new score and the Kobayashi score displayed high sensitivity (0.72 and 0.70 respectively) and specificity (0.67 and 0.68 respectively), while the Egami and Sano scores showed high specificity (0.71 and 0.81 respectively) but relatively low sensitivity (0.56 and 0.45 respectively). The odds ratios (ORs) for the new score, the Kobayashi score, the Egami score and the Sano score were 5.34 (95% confidence interval [CI] 3.22-8.85), 4.87 (95% CI 2.96-8.01), 3.14 (95% CI 1.96-5.03) and 3.53 (95% CI 2.17-5.77) respectively. CONCLUSIONS The predictive validity of the combination of NLR≥3.83 and PLR≥150, which is a simple and convenient indicator, was equal to or higher than that of the other risk scores. This suggests that the new score could be a widely available marker for predicting IVIG resistance in KD.
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Affiliation(s)
- Seiichiro Takeshita
- Division of Nursing, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takashi Kanai
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Pediatrics, Japan Self-Defense Forces Central Hospital, Setagaya, Tokyo, Japan
| | - Yoichi Kawamura
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Yoshida
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
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Efficacy of Four Scoring Systems in Predicting Intravenous Immunoglobulin Resistance in Children with Kawasaki Disease in a Children's Hospital in Beijing, North China. J Pediatr 2017; 184:120-124. [PMID: 28043682 DOI: 10.1016/j.jpeds.2016.12.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/16/2016] [Accepted: 12/05/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the predictive efficacies of 4 existing scoring systems for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) in hospitalized children with KD in a children's hospital affiliated with the Capital Institute of Pediatrics, Beijing, China. STUDY DESIGN We retrospectively analyzed 1569 children with KD treated at our children's hospital between January 2010 and December 2015. Age, sex, clinical manifestations, and pretreatment hematologic indicators were recorded. Scores were assigned using 4 existing scoring systems: Egami, Kobayashi, San Diego, and Formosa. A 4-case table test was used to determine prediction efficacies. RESULTS There were 63 IVIG-resistant cases (41 males, 22 females; average age, 2.5 years). Nine cases were classified as high risk for IVIG resistance by the Egami system, and this system had a sensitivity of 14% and a specificity of 86%. Ten cases had Kobayashi high-risk scores, and this system had a sensitivity of 16% and a specificity of 85%. The San Diego system assigned 60 cases as high-risk, and had a sensitivity of 95% and specificity of 3%. Finally, 27 cases had Formosa scores in the high-risk category, and this system had a sensitivity of 43% and a specificity of 47%. CONCLUSIONS None of the evaluated systems for assessing the risk for IVIG resistance displayed the combination of sensitivity and specificity necessary for screening. Our analyses show that the 4 scoring systems have limited utility in predicting IVIG resistance among patients with KD in our population.
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