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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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Topçu U, Sahin N, Kayabey Ö, Babaoğlu K. Retrospective evaluation of 130 cases with kawasaki disease follow-up in a tertiary care center in Turkey between 1999 and 2019: a 20-year experience. Postgrad Med 2024; 136:189-197. [PMID: 38420903 DOI: 10.1080/00325481.2024.2325334] [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: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Kawasaki disease (KD), which is a medium vessel vasculitis, is common in Asian countries and is the most common cause of childhood-acquired heart diseases in developed countries. However, disease course and epidemiological data are limited in non-Asian developing countries like ours. We aimed to evaluate the clinical features and prognosis of patients with KD in our country and ethnicity, one of the referee centers of our country. METHODS Patients with KD in our center for the last 20 years in the pre-COVID-19 pandemic era were included in the study. The clinical and laboratory findings, treatments, and follow-up findings were reviewed retrospectively in different age groups. RESULTS Of the 130 patients, 82 (63%) were male. The median age at diagnosis was 2.97 years (2 months-11.5 years). Thirty-six (27.7%) patients were diagnosed with incomplete KD, and there was no significant laboratory difference between incomplete KD and complete KD patients. Thirty-three (25.3%) patients had coronary artery lesions (CAL), and it persisted in only 3 of 33 patients. One of 15 patients with IVIG resistance had CAL. The independent risk factors were days of illness at initial IVIG administration for CAL (p = 0.013, OR [95%CI] = 1.20 [1.04-1.38]) and low hemoglobin (p = 0.003, OR [95%CI] = 0.51 [0.33-0.79]) and low sodium for IVIG resistance (p = 0.012, OR [95%CI] = 0.81[0.69-0.95]). CONCLUSIONS The rate of CAL is approximately three times higher in our results than in the Japanese data in recent years. We showed that the time of IVIG administration is the most critical factor for preventing CAL. Wide-ranging studies are needed to decently predict the disease process according to the age and region of patients.
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Affiliation(s)
- Uğur Topçu
- Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Nihal Sahin
- Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Özlem Kayabey
- Department of Pediatric Cardiology, Mersin City Hospital, Mersin, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University, Kocaeli, Turkey
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Rubio-Granda A, Murias Loza S, Covadonga Fernández Barrio B, Menéndez Cuervo S, Silva Guisasola J, Concha-Torre A. Coronary Bypass in an Adolescent With Systemic Lupus Erythematosus and Acute Coronary Syndrome. Pediatrics 2024; 153:e2023063832. [PMID: 38327255 DOI: 10.1542/peds.2023-063832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/09/2024] Open
Abstract
A 12-year-old female with active pediatric juvenile systemic lupus erythematosus presented to the emergency department because of episodes of oppressive central thoracic pain associated with pallor, sweating, and muscle weakness that persisted for >30 minutes. During the last episode, the electrocardiogram revealed alterations in cardiac repolarization coincident with progressive troponin T elevation. An angio computed tomography revealed a 20 mm long complete segmental obstruction of the proximal anterior descending artery that was confirmed by angiography. Because this extensive occlusion did not permit a noninvasive procedure, an off-pump coronary bypass of the internal mammary artery to the anterior descending artery was performed without complication. Six months after the procedure, myocardial function was good. To our knowledge, this is the first case report of an adolescent girl with acute coronary syndrome complicating juvenile systemic lupus erythematosus that was treated with a surgical procedure.
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Affiliation(s)
| | | | | | | | - Jacobo Silva Guisasola
- Head Cardiac Surgery Unit, Heart Area Department, University Hospital Central of Asturias, Oviedo, Spain
| | - Andrés Concha-Torre
- Pediatric ICU, Department of Pediatrics
- Department of Pediatrics, Instituto de Investigación Sanitaria del Principado de Asturas (ISPA), Principado de Asturias, Spain
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La Vecchia A, Stracquadaino R, Mauri L, Baselli LA, Abdallah R, Cucchetti M, Colli AM, Agostoni C, Dellepiane RM. Risk factors and scores for prediction of coronary artery aneurysms in Kawasaki disease: a European monocentric study. BMC Pediatr 2024; 24:139. [PMID: 38395821 PMCID: PMC10885636 DOI: 10.1186/s12887-024-04623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Japanese Kawasaki disease (KD) risk scores cannot be adopted in non-Japanese patients. In North American populations a baseline coronary artery Z-score > 2 and the Son score are associated with coronary artery aneurysms (CAAs) at 4 and 8 weeks from disease onset. In European populations, the Kawanet and Kawanet-echo scores are associated with intravenous immunoglobulin resistance. This study aims to evaluate the association between KD risk scores and baseline coronary artery Z-scores with CAAs at one, two, and six months in a European population. METHODS Historical cohort study of all the children diagnosed with KD in a tertiary care hospital in Milan, Italy, between 1st January 2015 and 31st May 2021. Univariate and multivariate (adjusting for age and corticosteroid therapy) logistic regression analyses were used to study the association between the risk scores, a baseline Z-score ≥ 2 and ≥ 2.5 with CAAs. RESULTS Eighty-nine patients were diagnosed with KD at our Centre, and 12 were excluded based on the exclusion criteria. We included 77 patients, 51 (66%) males, and 26 (34%) females, with a median age at presentation of 27 months (IQR 13-46). A baseline Z-score ≥ 2 was correlated with CAAs at one and two-month follow-ups (odds ratio (OR) 10, 95% confidence interval (CI) 2-72, and OR 18, CI 3-357) but not at six-month follow-up. The Son score showed an association with one and two-month follow-up CAAs (OR 3, CI 1.3-7, and OR 3, CI 1.3-8) but not with a six-month follow-up. CONCLUSIONS Patients with a baseline Z-score ≥ 2 are at higher risk for CAAs in the long term. The Son score should be tested in larger European samples. Further studies should keep the observational periods longer than 8 weeks from KD onset.
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Affiliation(s)
- Adriano La Vecchia
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Pediatric Area, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, Milan, 20122, Italy
| | - Rita Stracquadaino
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Lucia Mauri
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
- Department of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Augusta Baselli
- Pediatric Area, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, Milan, 20122, Italy
| | - Rozan Abdallah
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Martina Cucchetti
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Anna Maria Colli
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
- Department of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy.
- Pediatric Area, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, Milan, 20122, Italy.
| | - Rosa Maria Dellepiane
- Pediatric Area, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, Milan, 20122, Italy
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Reddy Konda VV, Jindal AK, Nadig PL, Banday AZ, Vinay K, Singh S. Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition. Rheumatology (Oxford) 2024; 63:392-398. [PMID: 37202349 DOI: 10.1093/rheumatology/kead213] [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: 12/22/2022] [Revised: 04/01/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. METHODS Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. RESULTS We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). CONCLUSION Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.
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Affiliation(s)
- Vishnu Vardhan Reddy Konda
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallavi L Nadig
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aaqib Zaffar Banday
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jiang S, Li M, Xu K, Xie Y, Liang P, Liu C, Su Q, Li B. Predictive factors of medium-giant coronary artery aneurysms in Kawasaki disease. Pediatr Res 2024; 95:267-274. [PMID: 37670043 PMCID: PMC10798897 DOI: 10.1038/s41390-023-02798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND We aimed to examine predictive measures for medium and giant coronary artery aneurysms (CAA) in Kawasaki disease (KD) patients. METHODS Patients who were diagnosed with KD from 2015 to 2021 were retrospectively reviewed. The clinical and laboratory data were compared between medium-giant group and non-medium-giant group. RESULTS A total of 1331 KD patients were investigated, of whom 63 patients (4.7%) developed medium-giant CAA including 27 patients (2%) with giant CAA. Sex, age, fever duration, intravenous immunoglobulin (IVIG) resistance, platelet count, and albumin level independently predicted medium or giant CAA by multivariate logistic regression analysis. Male, age, duration of fever, IVIG resistance, platelet count, hemoglobin, and erythrocyte sedimentation rate were independent predictors for giant CAA. The two new scoring systems using these factors in identifying patients with medium-giant CAA and giant CAA had respectively sensitivities of 86.89% and 92.59%, and specificities of 81.65% and 87.93%. Validation in 2021 dataset (193 KD patients) showed comparable sensitivity and specificity to development dataset. CONCLUSIONS Male, age, fever duration, IVIG resistance, platelet count, albumin, hemoglobin, and erythrocyte sedimentation rate might be significant predictors of medium and giant CAA. The sensitivity and specificity in our risk prediction model were higher than in previous research. IMPACT This is the first study to search for risk factors and establish a prediction model for the development of medium-giant CAA in the Chinese population using z-scores and absolute inner diameter values based on large sample sizes. The sensitivity and specificity in our model were higher than in previous studies. Our research could help clinicians better predict medium-giant CAA and choose more appropriate treatment.
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Affiliation(s)
- Saitong Jiang
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Meng Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Kun Xu
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Ying Xie
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Piaohong Liang
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Cong Liu
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qiru Su
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Boning Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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Al Zubaidi A, Ghatasheh G, Karuppaswamy V, Narchi H. Epidemiology of Kawasaki Disease, Its Incomplete Form and Outcomes: A Single-Institution Experience in the United Arab Emirates. Cureus 2023; 15:e51320. [PMID: 38288209 PMCID: PMC10823459 DOI: 10.7759/cureus.51320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Background and objective Kawasaki disease is a childhood vasculitis, the leading cause of acquired heart disease in children worldwide. Data is lacking in the United Arab Emirates and the Middle East region. We aimed to review the clinical characteristics of patients diagnosed with Kawasaki disease, the response to intravenous immunoglobulin, and the short-term and long-term echocardiographic findings. Study design This is a retrospective cohort study involving patients diagnosed with Kawasaki disease in Tawam Hospital from January 2011 to December 2021. Results A total of 74 patients with a mean age of 36 months were diagnosed with Kawasaki disease, of whom 18 (24%) were below one year of age. Complete Kawasaki disease criteria were fulfilled in 36 patients (49%), while the remaining 38 (51%) were incomplete Kawasaki disease. A positive response to intravenous immunoglobulin occurred in less than 36 hours in 60 patients (84.5%). Echocardiography at the diagnosis of Kawasaki disease was performed on 71 patients, of whom 18 (25.35%) had cardiac involvement. The odds of coronary artery aneurysms in Kawasaki disease were 0.12 at diagnosis. Patients younger than 12 months were significantly more likely to be diagnosed with incomplete Kawasaki disease as compared to older patients (24 vs. 14 patients, P = 0.01). In the multivariate logistic regression analysis, only corticosteroid therapy remained statistically significantly associated with the development of coronary aneurysms (adjusted odds ratio (OR) 13.02, ci 1.05, 161.18; P = 0.045). Conclusion A high proportion of patients with Kawasaki disease had an atypical presentation, especially when under one year of age. There was no association between clinical characteristics or laboratory findings and prompt response to treatment within 36 hours.
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Affiliation(s)
| | - Ghassan Ghatasheh
- Department of Pediatric Infectious Diseases, Tawam Hospital, Al Ain, ARE
| | | | - Hassib Narchi
- Pediatrics, United Arab Emirates University, Al Ain, ARE
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VAROL F, DEDEOĞLU R, KILIÇ A, BAKAR MT, ADROVİC A, ŞAHİN S, YILDIZ M, BARUT K, ÇAM H, KASAPÇOPUR Ö. Retrospective analysis of children diagnosed with Kawasaki disease. Turk J Med Sci 2023; 53:979-989. [PMID: 38031949 PMCID: PMC10760559 DOI: 10.55730/1300-0144.5662] [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: 01/28/2022] [Revised: 08/18/2023] [Accepted: 02/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The aim of our study was to evaluate the long-term impacts of Kawasaki disease on our patients regarding coronary involvement demographic characteristics, treatment regimens, and clinical course. METHODS Our study included 104 patients diagnosed and hospitalized with Kawasaki disease in our center, from January 2004 to January 2019. In our study, patients were divided into three groups according to coronary artery involvement. Patients in group 1 had no echocardiographic findings, while the ones in group 2 had coronary artery dilatation and ones in group 3 had coronary artery aneurysm (CAA). RESULTS Among 104 patients, the median age was 9.15 (3.0-22.0) years, and 61 of the patients were male while 43 of the patients were female. With a wide range of 1.50-16.50 years of follow-up time, the median diagnosis age of our patients was 31 months (3.0-164.0). Fever duration (median day 10 (5-21), p = 0.025) was statistically significantly higher in group 3. Blood C-reactive protein (CRP) levels, white blood cell (WBC) counts, and neutrophil counts were significantly higher in group 3. There was a statistically significant difference between patients in group 3 and group 2 in which the lowest strain deformation values were in the patients of group 3. In contrast to group 1, the time for initiation of IVIG therapy is significantly prolonged both in group 2 (median: 9.5 days, p = 0.028) and group 3 (median: 10 days, p = 0.036). DISCUSSION In our study, serum CRP levels, WBC count, and neutrophil count were higher in patients with coronary artery abnormalities, in agreement with the previous studies. In the light of our results, we consider that the most important determining factor for the development of coronary artery aneurysm is the time of intravenous immunoglobulin (IVIG) administration.
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Affiliation(s)
- Fatih VAROL
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Şehit Profesör Dr. İlhan Varank Training and Research Hospital, İstanbul,
Turkiye
| | - Reyhan DEDEOĞLU
- Department of Pediatric Cardiology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Aziz KILIÇ
- Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Murat T. BAKAR
- Department of Public Health, Medical School, Marmara University, İstanbul,
Turkiye
| | - Amra ADROVİC
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Sezgin ŞAHİN
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Mehmet YILDIZ
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Kenan BARUT
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Halit ÇAM
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Şehit Profesör Dr. İlhan Varank Training and Research Hospital, İstanbul,
Turkiye
| | - Özgür KASAPÇOPUR
- Department of Pediatric Rheumatology, Cerrahpaşa Medical School, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
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Cui Z, Luo F, Wang J, Diao J, Pan Y. Bibliometric and visual analysis of Kawasaki disease in children from 2012 to 2022. Front Pediatr 2023; 11:1142065. [PMID: 37576134 PMCID: PMC10413569 DOI: 10.3389/fped.2023.1142065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background In recent years, the incidence of Kawasaki disease among the pediatric population has experienced a significant increase. With complications mainly affecting the cardiovascular system, Kawasaki disease has received widespread attention from scholars worldwide. Numerous articles on Kawasaki disease in children have been published far. However, there is a lack of studies that use visualization methods to perform a bibliometric analysis of the relevant literature. This study aims to obtain overall information on the output characteristics of publications on childhood Kawasaki disease between 2012 and 2022 through bibliometric analysis, identify research hotspots and frontiers, and provide new ideas and references for future clinical and scientific research. Methods Literature meeting the inclusion criteria was screened from the Web of Science Core Collection, PubMed, and Scopus databases. Visual analysis of the literature by country, institution, journal, author, keywords, and references was performed using Citespace (6.1.R6), VOSviewer (1.6.18), and the online bibliometric website (https://bibliometric.com/). Results A total of 4,867 eligible publications were included. The number of annual publications is generally rising, rapidly increasing since 2019. Among countries and institutions, China and KAOHSIUNG CHANG GUNG MEMORIAL HOSPITAL have the highest output of articles. With 104 publications, Ho-Chang Kuo has a high impact in the field of KD. The most cited author is Jane W. Newburger. The most prolific journal is FRONTIERS IN PEDIATRICS. CIRCULATION is the most frequently co-cited journal. The most popular keyword in frequency and centrality is "immunoglobulin". The reference with the highest burst intensity was Verdoni L, LANCET, 2020. Conclusion Kawasaki disease in children remains a hot topic among pediatricians worldwide and is receiving increasing attention. We innovated the "national-institutional-journal" model, which promotes further international cooperation in this field. The hot topics in the field of pediatric KD are "KD pathogenesis", "immunoglobulin resistance and complementary therapy", and "cardiovascular complications". Frontiers include disease-related ("multisystem inflammatory syndrome", "coronavirus disease 2019", "hypotension"), treatment-related ("procalcitonin", " anakinra"), and pathogenesis ("polymerase chain reaction").
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Affiliation(s)
- Zhengjiu Cui
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fei Luo
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinjuan Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Juanjuan Diao
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yueli Pan
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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10
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Gorji M, Taraz M, Gharib B, Ziaee V. Giant Coronary Aneurysms with Multiple Large Resistant Thromboses in an 8-Month-Old Boy with IVIg-Resistant Kawasaki Disease: A Case Report. J Tehran Heart Cent 2023; 18:224-227. [PMID: 38146411 PMCID: PMC10748654 DOI: 10.18502/jthc.v18i3.14118] [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: 05/12/2023] [Accepted: 06/20/2023] [Indexed: 12/27/2023] Open
Abstract
Kawasaki disease is an acute self-limiting systemic vasculitis in childhood, resulting in arterial swelling or inflammation and eventually leading to cardiovascular problems, such as coronary artery aneurysms. Based on previous studies, serum sodium ≤133 mmol/L, albumin ≤3.2 g/dL, alanine transaminase ≥80 U/L, and neutrophil percentage ≥80% at diagnosis are risk factors for intravenous immunoglobulin (IVIg). However, the prevalence of resistance to Ig among children with Kawasaki disease varies among different countries due to diversity in evaluation, treatment, and diagnosis. Approximately, 10% to 20% of patients have IVIg-resistant Kawasaki disease. As the probability of coronary artery damage associated with IVIg-resistant Kawasaki disease is higher than that with IVIg-sensitive Kawasaki disease, the early detection and appropriate treatment of IVIg-resistant Kawasaki disease can decrease the probability of damage to coronary arteries and hospital lengths of stay and cost. Kawasaki disease in early infancy is uncommon, and sometimes it occurs with thrombosis and peripheral gangrene. A positive genetic background may play a role in susceptibility to thrombosis. We herein describe a patient suffering from an IVIg-resistant Kawasaki disease with severe coronary artery thrombosis and positive genetic mutation. Medical treatment resolved the thrombosis, but the coronary arteries remained dilated.
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Affiliation(s)
- Mojtaba Gorji
- Department of Pediatric Cardiology, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Maryam Taraz
- Department of Pediatric Cardiology, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Behdad Gharib
- Department of Pediatric Cardiology, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Vahid Ziaee
- Department of Pediatric Rheumatology, Children's Medical Center, Pediatric Center of Excellence, Tehran, Iran
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11
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Giryes S, McGonagle D. Immune and non-immune mechanisms that determine vasculitis and coronary artery aneurysm topography in Kawasaki disease and MIS-C. Clin Exp Rheumatol 2023; 22:103240. [PMID: 36496111 DOI: 10.1016/j.autrev.2022.103240] [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: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
The overlap between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) including coronary artery aneurysms (CAA) and broadly shared gastrointestinal and mucocutaneous disease is poorly defined. In this perspective, we highlight common age-related extravascular epicardial microanatomical and immunological factors that might culminate in CAA expression in both MIS-C and KD. Specifically, the coronary vasa vasorum originates outside the major coronary arteries. Widespread inflammation in the epicardial interstitial compartment in shared between KD and MIS-C. Age-related changes in the neonatal and immature coronary vasculature including the impact of coronary artery biomechanical factors including coronary vessel calibre, age-related vessel distensibility, flow, and vessel neurovascular innervation may explain the decreasing CAA frequency from neonates to older children and the virtual absence of CAA in young adults with the MIS-C phenotype. Other KD and MIS-C features including mucocutaneous disease with keratinocyte-related immunopathology corroborate that disease phenotypes are centrally influenced by inflammation originating outside vessel walls but a potential role for primary coronary artery vascular wall inflammation cannot be excluded. Hence, common extravascular originating tissue-specific responses to aetiologically diverse triggers including superantigens may lead to widespread interstitial tissue inflammation characteristically manifesting as CAA development, especially in younger subjects. Given that CAA is virtually absent in adults, further studies are needed to ascertain whether epicardial interstitial inflammation may impact on both coronary artery physiology and cardiac conduction tissue and contribute to cardiovascular disease- a hitherto unappreciated consideration.
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Affiliation(s)
- Sami Giryes
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, United Kingdom.
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12
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Eleftheriou D, Moraes YC, Purvis C, Pursell M, Morillas MM, Kahn R, Mossberg M, Kucera F, Tulloh R, Standing JF, Swallow V, McCormack R, Herberg J, Levin M, Wan M, Klein N, Connon R, Walker AS, Brogan P. Multi-centre, randomised, open-label, blinded endpoint assessed, trial of corticosteroids plus intravenous immunoglobulin (IVIG) and aspirin, versus IVIG and aspirin for prevention of coronary artery aneurysms (CAA) in Kawasaki disease (KD): the KD CAA prevention (KD-CAAP) trial protocol. Trials 2023; 24:60. [PMID: 36703139 PMCID: PMC9879235 DOI: 10.1186/s13063-022-07051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limiting inflammatory vasculitis affecting predominantly medium-sized arteries, particularly the coronary arteries. A number of recent studies conducted in different European countries have demonstrated alarmingly high coronary complications despite treatment with intravenous immunoglobulin (IVIG). These high complication rates now emphasize the need for an urgent reappraisal of IVIG as the sole primary therapeutic agent for KD. The Kawasaki disease CAA prevention (KD-CAAP) trial will test the hypothesis that immediate adjunctive corticosteroid treatment to standard of care IVIG and aspirin will reduce coronary artery aneurysm (CAA) rates in unselected KD patients across Europe. METHODS KD-CAAP is a multicentre, randomised, controlled, open-label, blinded endpoint assessed trial that will be conducted across Europe supported by the conect4children pan-European clinical trials network. Patients with KD who satisfy the eligibility criteria will be randomised (1:1) to receive either oral prednisolone 2 mg/kg/day plus standard of care therapy IVIG (2 g/kg) and aspirin (40 mg/kg/day); or IVIG and aspirin alone. Further management is dictated by temperature and C-reactive protein (CRP) responses. Co-primary outcomes are as follows: (i) any CAA within the 3 months of trial follow-up; (ii) average estimate of maximum coronary Z-score at weeks 1, 2 and 6 adjusting for rescue treatment. Additional outcomes will be assessed including cost effectiveness, quality of life, corticosteroid toxicity and other safety outcomes. DISCUSSION Several recent studies have indicated that coronary complications associated with KD across Europe are much higher than early trials of IVIG had initially suggested. KD-CAAP directly addresses this issue by exploring the therapeutic benefit of adjunctive corticosteroids in unselected KD cases. If we find that corticosteroids prevent CAA and are safe, this is a cheap and widely available intervention that could be implemented immediately for the benefit of children. TRIAL REGISTRATION ISRCTN71987471- March 31, 2020; Eudract 2019-004433-17.
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Affiliation(s)
- Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Yolanda Collaco Moraes
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Cara Purvis
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Molly Pursell
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Marta Merida Morillas
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Robin Kahn
- Department of Paediatrics, Lund University, Clinical Sciences, Lund, Sweden
| | - Maria Mossberg
- Department of Paediatrics, Lund University, Clinical Sciences, Lund, Sweden
| | | | | | - Joseph F Standing
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Rachael McCormack
- Societi Foundation CIO, The UK Foundation for Kawasaki Disease, Newark, UK
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Mandy Wan
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roisin Connon
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Ann Sarah Walker
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Paul Brogan
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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13
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Bressieux-Degueldre S, Gradoux E, Di Bernardo S, Sekarski N. Complete and incomplete Kawasaki disease: Clinical differences and coronary artery outcome from a national prospective surveillance study in Switzerland. Front Pediatr 2023; 11:1137841. [PMID: 37020652 PMCID: PMC10067721 DOI: 10.3389/fped.2023.1137841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction The aim of this national prospective surveillance study was to compare the clinical presentation, laboratory findings, treatment, and coronary artery outcome in patients with incomplete and complete Kawasaki disease (KD). Methods Between March 2013 and February 2019, children with a diagnosis of complete and incomplete KD were reported by the Swiss Paediatric Surveillance Unit and prospectively enrolled. Clinical data, laboratory values, treatment, and echocardiographic features were collected at diagnosis and 1 year of follow-up. Data were compared between children with complete or incomplete KD. Results A total of 351 questionnaires were registered from children with a diagnosis of KD. Of them, 219 (62.4%) children had complete KD, and 132 (37.6%) children had incomplete KD. Children with incomplete KD were younger and had a longer-lasting fever; however, there were no differences in the level of C-reactive protein. All but four children received intravenous immunoglobulin treatment, whereas 14% of children were treated with corticosteroids. Children with incomplete KD were more often treated with corticosteroids than children with incomplete KD (p = 0.01). At diagnosis, 39 (11.1%) patients had only coronary artery dilation and 57 (16.2%) had at least one coronary artery aneurysm. There were no differences in coronary artery involvement between the two groups. At follow-up, 273 of 294 (92.8%) patients had no coronary artery involvement, with no difference between the two groups (p = 0.609). The overall incidence of coronary artery aneurysms at diagnosis was 16.2%. At follow-up, most coronary artery aneurysms had regressed, and coronary artery aneurysms were present in only 5.8% of the patients. Coronary artery aneurysms were slightly more frequent in patients with incomplete KD at follow-up (p = 0.039) but not at diagnosis (p = 0.208). Conclusion Although the clinical presentation in children with incomplete and complete KD differs, the absence of coronary artery involvement does not. The use of corticosteroids appears to be preventive against the development of coronary artery aneurysms in these patients. However, the results of this study suggest a lower rate of coronary artery aneurysm regression in patients with incomplete KD. Further studies on a larger scale are needed to assess the risk of non-regression of coronary artery aneurysms in this particular group of patients.
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Affiliation(s)
- S Bressieux-Degueldre
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - E Gradoux
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - S Di Bernardo
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - N Sekarski
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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14
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Cai WJ, Ding SG. Retrospective analysis of clinical characteristics and related influencing factors of Kawasaki disease. Medicine (Baltimore) 2022; 101:e32430. [PMID: 36596080 PMCID: PMC9803503 DOI: 10.1097/md.0000000000032430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To compare the clinical characteristics of complete Kawasaki disease (KD) and incomplete Kawasaki disease (IKD), and analyze the possible risk factors of coronary artery lesion (CAL) in KD. The clinical data of 139 children with KD admitted to the hospital from January 2016 to June 2022 were analyzed retrospectively. The differences of clinical characteristics between children with KD and children with IKD were compared. The risk factors of CAL were analyzed using univariate and multivariate logistic regression. Comparison of clinical characteristics between KD and IKD groups, the results showed there was significant difference in terms of conjunctival congestion, rash, lymph node enlargement, hand and foot redness, intravenous immune globulin non reaction and fever time (P < .05). Comparison of laboratory indicators between 2 groups, the results showed that there was significantly difference in the levels of neutrophils (P < .05). 15 cases (15.31%) in KD group were complicated with CAL, and 17 cases (41.46%) in IKD group were complicated with CAL, and the results showed there was a significant difference between the 2 groups (P < .05). Univariate analysis showed that the age and Hb of children with CAL were lower than those of children with nCAL, while C-reactive protein, NT-proBNP, NEUT, and ESR were higher than those of children with nCAL (P < .05). Multivariate analysis showed that the increase of NT-proBNP and the decrease of Hb may be independent risk factors for the occurrence of CAL in children with KD. The clinical manifestation of children with IKD is not typical. Compared with KD children, the fever time is longer and the incidence of CAL is higher. Under-age, increased NT-proBNP and decreased Hb may be independent risk factors for CAL in KD children.
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Affiliation(s)
- Wen-Juan Cai
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
| | - Sheng-Gang Ding
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
- * Correspondence: Sheng-Gang Ding, Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China (e-mail: )
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15
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Tsuchihashi T, Kakimoto N, Kitano N, Suenaga T, Ikeda K, Izui M, Kobayashi N, Yoshimura K, Nakamura Y, Suzuki H. Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan. Pediatr Int 2022; 64:e15391. [PMID: 36256501 DOI: 10.1111/ped.15391] [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: 04/16/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z-score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD. METHODS The 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z-score, treatment by KD treatment stage, and predictors of CAAs. RESULTS The response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z-scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second-line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third-line treatment. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs. CONCLUSIONS Using the Z-score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year are useful predictors of CAAs.
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Affiliation(s)
- Tomoya Tsuchihashi
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Kakimoto
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Naomi Kitano
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Health Administration Center, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Suenaga
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kazuyuki Ikeda
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Izui
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Division of Pediatrics, Kobetokushukai Hospital, Hyogo, Japan
| | - Naho Kobayashi
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Division of Pediatrics, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Ken Yoshimura
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Yoshikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Suzuki
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan.,Department of Pediatrics, Wakayama Tsukushi Medical and Welfare Center, Iwade, Japan
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16
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Liu R, Zhao H, Gao X, Liang S. Is Coronary Artery Ectasia a Progressive Disease? A Self-Controlled Retrospective Cohort Study. Front Cardiovasc Med 2021; 8:774597. [PMID: 34938789 PMCID: PMC8685394 DOI: 10.3389/fcvm.2021.774597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress. Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time. Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis. Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.
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Affiliation(s)
- Ruifeng Liu
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Huiqiang Zhao
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiangyu Gao
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Siwen Liang
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
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