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Natarajan RK, Bhoopalan SV, Cross C, Shah R, Rothman A. Novel Score to Predict Immunoglobulin Resistance in Kawasaki Disease. Pediatr Cardiol 2023; 44:1546-1551. [PMID: 37173579 DOI: 10.1007/s00246-023-03175-0] [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] [Received: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
To evaluate existing scoring systems and develop a new model to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). A retrospective cohort study performed between 2004 and 2017 identified 115 patients treated with IVIG for classic or incomplete KD. In our practice, IVIG resistance was defined as fever for > 24 h and patients were divided into responders and non-responders. A univariate analysis was performed to identify independent predictors of IVIG resistance. The predictors were combined into a new scoring system and compared with existing scoring systems. Sixty-five patients had classic KD and 50 had incomplete KD. Among the 115 patients, 80 (69.6%) responded and the remaining 35 were resistant (30.4%) to IVIG. Of the 35 resistant patients, 16 patients had incomplete KD. Hispanic children comprised 43% of our sample population. Coronary artery abnormalities developed in 14 of the 35 IVIG-resistant patients (39%). Univariate analysis showed that IVIG-resistant patients were older and present with lower platelets, potassium, and creatinine (P < 0.05). Multivariate logistic regression analysis used platelets, potassium, body surface area (BSA), and creatinine to devise the Las Vegas Scoring System (LVSS), which demonstrated a sensitivity of 76.2% and a specificity of 68.6%. Compared to published data, we observed a higher rate of IVIG resistance and coronary artery abnormalities in our patient population. The LVSS (using platelets, potassium, BSA, and creatinine) showed higher specificity and comparable sensitivity to other scoring systems devised to predict IVIG resistance.
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Affiliation(s)
- Rupesh Kumar Natarajan
- Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA.
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Senthil Velan Bhoopalan
- Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA
- Department of Hematology, and Bone Marrow Transplantation and Cell Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chad Cross
- Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA
- Department of Epidemiology & Biostatistics, UNLV School of Public Health, Las Vegas, NV, USA
| | - Rita Shah
- Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA
| | - Abraham Rothman
- Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA
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Ouldali N, Dellepiane RM, Torreggiani S, Mauri L, Beaujour G, Beyler C, Cucchetti M, Dumaine C, La Vecchia A, Melki I, Stracquadaino R, Vinit C, Cimaz R, Meinzer U. Development of a score for early identification of children with Kawasaki disease requiring second-line treatment in multi-ethnic populations in Europe: A multicentre retrospective cohort study. Lancet Reg Health Eur 2022; 22:100481. [PMID: 35982834 PMCID: PMC9379661 DOI: 10.1016/j.lanepe.2022.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Early identification of high-risk patients is essential to stratify treatment algorithms of Kawasaki disease (KD) and to appropriately select patients at risk for complicated disease who would benefit from intensified first-line treatment. Several scores have been developed and validated in Asian populations but have shown low sensitivity in predicting intravenous immunoglobulin (IVIG) resistance in non-Asian populations. We sought methods to predict the need for secondary treatment after initial IVIG in non-Asian populations. Methods We conducted a retrospective, multicenter study including consecutive patients with KD admitted to two tertiary pediatric hospitals in France and Italy from 2005 to 2019. We evaluated the performance of the Kawanet-score and compared it with the performances of initial echocardiography findings, and of a newly proposed score combining the Kawanet-score and initial echocardiography findings. For each score, we assessed the AUC, sensitivity and specificity for predicting the need for second-line treatment. Findings We included 363 children with KD, 186 from France and 177 from Italy, of whom 57 (16%) required second-line therapy after the first IVIG dose. The Kawanet score, coronary artery dilation or aneurysm with maximal Z-score ≥2.0 at baseline, and abnormal initial echocardiography had a sensitivity of 43%, 55% and 65% and a specificity of 73%, 78%, 73%, respectively, for predicting the need for second-line treatment. The Kawanet-score was significantly improved by combining it with initial echocardiography findings. The best predictive performance (Sensitivity 76%, Specificity 54%) was obtained by combining the Kawanet-score with abnormal initial echocardiography, defined by the presence of either coronary artery maximal Z-score ≥2.0, pericarditis, myocarditis and/or ventricular dysfunction. This score predicted the need for second-line treatment in European, African/Afro-Caribbean and Asian ethnicity with a sensitivity of 80%, 65% and 100%, respectively, and a specificity of 56%, 51% and 61%, respectively. Interpretation Our study proposes a score that we named the Kawanet-echo score, which allows early identification of children with KD who require a second-line treatment in multi-ethnic populations in Europe. Funding None.
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Refractory Kawasaki disease: modified methylprednisolone regimen decreases coronary artery dilatation. Pediatr Res 2022; 91:1542-1550. [PMID: 34021270 DOI: 10.1038/s41390-021-01576-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of corticosteroids in Kawasaki disease (KD) is still controversial. The aim of this study was to investigate the safety and effectiveness of modified methylprednisolone (mPSL) regimen as an initial treatment for refractory KD. METHODS This is a real-world observational study. We identified refractory KD with a self-developed scoring system. Patients were divided into the intravenous immunoglobulin (IVIG) + mPSL group and the IVIG group. Clinical outcomes and changes in coronary arteries after the treatment during a 12-week period were observed. Propensity-score matching was used to analyze those patients with similar baseline characteristics. RESULTS Of a total of 168 patients, 104 patients were assigned into the IVIG group and 64 patients into the IVIG + mPSL group. The therapeutic response rate of the IVIG + mPSL group was significantly higher than that of the IVIG group (98.4 vs 76.0%, P < 0.05). The IVIG + mPSL group had a shorter duration of fever and a higher rate of C-reactive protein decline than the IVIG group (1.17 ± 0.64 vs 1.81 ± 1.16 days; 88.1 vs 83.5%; P < 0.05). The luminal diameter and Z-score of the left circumflex coronary artery (LCX) were significantly smaller and lower in the IVIG + mPSL group than that in the IVIG group at weeks 2 and 12. CONCLUSIONS Modified mPSL regimen has minimal side effects. It might improve the initial response to IVIG and decrease the dilation of LCX for refractory KD. IMPACT Modified mPSL regimen (2-4 mg/kg/day, divided into 2-3 doses for 3-5 days, then 1 mg/kg/day, once a day for 3-5 days, then oral prednisone was tapered over 3-5 weeks in 5-7 days steps) as an intensive initial treatment can decrease LCX dilation in high-risk IVIG-resistant KD patients. Our self-developed scoring system has been proven validated and can be used to identify high-risk IVIG-resistant KD patients in North China. The present study provides an alternative therapeutic regimen for high-risk refractory KD patients.
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Li W, Zhang L, Wang Z, He X, Lin H, Wang Y, Yuan J, Xie X, Zhang X, Qin Y, Huang P. Predictors for Intravenous Immunoglobulin Resistance in Patients with Kawasaki Disease. Int J Clin Pract 2022; 2022:2726686. [PMID: 35989868 PMCID: PMC9365590 DOI: 10.1155/2022/2726686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Between 10 and 20% of Kawasaki disease (KD) patients are resistant to treatment with initial intravenous immunoglobulin (IVIG) and have a high risk of developing coronary artery lesions. Some studies have been conducted to identify predictive factors. However, the results are controversial. This study aims to identify the risk factors for IVIG-resistant KD patients in a Chinese population. METHODS We performed a retrospective analysis of medical records of consecutive KD patients from two medical centers in South China from January 2015 to December 2017. A total of 1281 KD patients were eligible for inclusion in this study and maintained follow-up for over 12 months. The KD patients were divided into two groups based on IVIG response. Clinical characteristics and laboratory variables were compared between the two groups. Multivariate logistic regression analysis was performed to identify the risk factors of IVIG resistance in KD patients. RESULTS Of the 1281 KD patients, 141 (11.0%) cases who were IVIG resistant to adjunctive therapies for primary treatment were classified as group 1. The remaining patients were in group 2 (n = 1140), classified as the control group. There was a significant difference in male to female ratio and the length of hospital stay between the two groups (P < 0.05). Group 1 had a higher white blood cell count (P=0.01) and C-reactive protein level (P < 0.01) before IVIG treatment than in group 2. Group 1 had a significantly higher white blood cell count and percentage of neutrophils after the IVIG infusion than in group 2 (P < 0.001). In addition, the mean values of C-reactive protein level and neutrophil percentage before and after treatment difference comparison were significantly different. Multivariate analysis showed that patients presenting with coronary artery lesions in the acute phase and a C-reactive protein level >100 mg/L at diagnosis were associated with IVIG resistance in KD. During the 12-month follow-up period, group 1 had an obviously higher incidence of coronary artery lesions than group 2, and the difference between the groups was statistically significant (P < 0.001). CONCLUSIONS Patients presenting with coronary artery lesions in the acute phase and elevated C-reactive protein levels before IVIG treatment might be a useful and important value for predicting IVIG resistance in KD. Risk assessment based on coronary artery lesions and C-reactive protein levels prior to the treatment may improve the outcome of IVIG resistance.
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Affiliation(s)
- Wei Li
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Zhouping Wang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiufang He
- Department of Pediatric Cardiovascular, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Huimei Lin
- Department of Medical Record, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Yanfei Wang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Jia Yuan
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaofei Xie
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xu Zhang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Youzhen Qin
- Department of Pediatric Cardiovascular, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ping Huang
- Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
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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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Zheng X, Li J, Yue P, Liu L, Li J, Zhou K, Hua Y, Li Y. Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?-Current evidence based on a meta-analysis. PLoS One 2021; 16:e0248812. [PMID: 33764989 PMCID: PMC7993784 DOI: 10.1371/journal.pone.0248812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Coronary artery lesion (CAL) caused by Kawasaki disease (KD) is a leading cause of acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAL. Although most of the current studies have shown a certain correlation between CAL and IVIG resistance, the conclusions are not completely consistent. Thus, we performed this meta-analysis to evaluate the association between IVIG resistance and CAL in KD. Methods PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through April 21, 2020 were searched to detect relevant studies. Data analysis was performed with STATA 15.1. Results A total of 53 relevant studies were eligible to this analysis, including 30312 KD patients, of which 4750 were IVIG resistance and 25562 were responders. There was a significant difference found between IVIG resistance and IVIG response groups in the incidence of CAL (P < 0.001, odds ratio (OR), 3.89; 95% confidence interval (CI) (3.18, 4.75)). The heterogeneity test results showed that the I2 value was 74.8%. The meta-regression analysis showed that the study regions might be the sources of heterogeneity. The subgroup analysis suggested that the incidence of CAL in the IVIG resistance group was still higher than that in the IVIG response group under different regions, IVIG resistance diagnostic criteria, CAL diagnostic criteria, and study types. Meanwhile, the sensitivity analysis did not find any significant impact from every single study. Conclusions This is the first meta-analysis to reveal the incidence of CAL was associated with IVIG resistance in KD patients. Further well-designed studies with uniform criteria are needed to evaluate the incidence of CAL in IVIG resistant patients.
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Affiliation(s)
- Xiaolan Zheng
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinhui Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Yue
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiawen Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics in West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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Guimarães ICB. Kawasaki Disease: Predictors of Intravenous Immunoglobulin Resistance and Cardiac Complications: New Perspectives? Arq Bras Cardiol 2021; 116:492-493. [PMID: 33909779 PMCID: PMC8159543 DOI: 10.36660/abc.20201353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Isabel Cristina Britto Guimarães
- Universidade Federal da BahiaFaculdade de Medicina da BahiaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina da Bahia, Salvador, BA – Brasil,Correspondência: Isabel Cristina Britto Guimarães • Universidade Federal da Bahia - Faculdade de Medicina da Bahia - Praça Ramos de Queiros, s/n, CEP 40026-010, Largo do Terreiro de Jesus, Salvador, BA – Brasil. E-mail:
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Faim D, Henriques C, Brett A, Francisco A, Rodrigues F, Pires A. Kawasaki Disease: Predictors of Resistance to Intravenous Immunoglobulin and Cardiac Complications. Arq Bras Cardiol 2021; 116:485-491. [PMID: 33470332 PMCID: PMC8159558 DOI: 10.36660/abc.20190758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of acquired cardiac disease in children, in developed countries. OBJECTIVES To identify predictive factors for resistance to intravenous immunoglobulin (IVIG), calculate the effectiveness of Japanese predictive models and characterize cardiac complications. METHODS Retrospective analysis of KD cases admitted in a Portuguese paediatric hospital between january 2006 and july 2018. ROC curves were used to determine predictive factors for resistance and the multivariate logistic regression analysis was used to develop the predictive model. A significance level of 5% was used. RESULTS 48 patients with a median age of 36 months were included. The IVIG resistance was 21%. Echocardiographic anomalies were noted in 46%, with coronary involvement in 25% of the sample population. As predictive variable of resistance, the C-reactive protein (CRP) presented an AUC ROC = 0.789, optimal cut-off value 15.1 mg/dL, sensitivity (Sn) 77.8% and specificity (Sp) 78.9%. The erythrocyte sedimentation rate (ESR) presented an AUC ROC = 0.781, optimal cut-off value 90.5 mm/h, Sn 66.7% and Sp 85.7%. The model with the two variables showed p = 0.042 and AUC ROC = 0.790. Predictive strength of Japanese models were: Kobayashi (Sn 63.6%, Sp 77.3%), Egami (Sn 66.7%, Sp 73.1%), Sano (Sn 28.6%, Sp 94.1%). CONCLUSION CRP and ESR are independent variables that were related to IVIG resistance, with optimal cut-off points of 15.1 mg/dL and 90.5 mm/h, respectively. About half of the patients had some form of cardiac involvement. The Japanese models appeared to be inadequate in our population. (Arq Bras Cardiol. 2021; 116(3):485-491).
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Affiliation(s)
- Diogo Faim
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal,Correspondência: Diogo Faim • Centro Hospitalar e Universitário de Coimbra EPE - Praceta, R. Prof. Mota Pinto, 3075 Coimbra 3000-075 – Portugal. E-mail:
| | - Cláudio Henriques
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
| | - Ana Brett
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Urgência e Unidade de Infeciologia, Coimbra - Portugal
| | - Andreia Francisco
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
| | - Fernanda Rodrigues
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Urgência e Unidade de Infeciologia, Coimbra - Portugal
| | - António Pires
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
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Huang CN, Wu FF, Chang YM, Huang HC, Lin MT, Wang JK, Wu MH. Comparison of risk scores for predicting intravenous immunoglobulin resistance in Taiwanese patients with Kawasaki disease. J Formos Med Assoc 2020; 120:1884-1889. [PMID: 33358267 DOI: 10.1016/j.jfma.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/PURPOSE Kawasaki disease (KD) is the most common type of acquired heart disease in children, and intravenous immunoglobulin (IVIG) therapy is the preferred treatment. Several risk scoring systems have been developed to predict IVIG resistance, which is important in KD management, including the Kobayashi, Egami, and Formosa scores. We evaluated the performance of these scoring systems with a KD patient cohort from Taiwan. METHODS We retrospectively analyzed the medical records of all KD patients admitted to our institution from 2012 to 2017. We compared the characteristics of IVIG-resistant and non-resistant patients and evaluated the predictive ability of the scoring systems for IVIG resistance. RESULTS We included 84 patients, with 73 receiving IVIG therapy. Eight patients were unresponsive to the first IVIG course. Compared to those with good response to therapy or spontaneous improvement, IVIG-resistant patients had a higher C-reactive protein level (16.1 mg/dL vs. 8.6 mg/dL, p < 0.001), higher percentage of segmented leukocytes (75.7% vs. 61.7%, p = 0.008), and lower albumin level (2.98 mg/dL vs. 3.78 mg/dL, p = 0.001). In determining IVIG resistance, the sensitivity and specificity varied among scoring systems (Kobayashi, 37.5% and 86.8%; Egami, 37.5% and 84.2%; and Formosa, 87.5% and 73.7%, respectively). The positive and negative predictive values of the Formosa score were 25.9% and 98.2%, respectively. CONCLUSION The Formosa score had the highest sensitivity in determining IVIG resistance. Although the positive predictive value was low, the negative predictive value could reach 98.2%. The Formosa score was superior to other scoring systems in predicting IVIG resistance in Taiwanese KD patients.
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Affiliation(s)
- Chi-Nan Huang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Fen-Fen Wu
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Ya-Mei Chang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Hsin-Chung Huang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Current Approach to the Evaluation and Management of Incomplete Kawasaki Disease in the Emergency Department. Pediatr Emerg Care 2020; 36:537-541. [PMID: 33122594 DOI: 10.1097/pec.0000000000002259] [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: 11/26/2022]
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of childhood and frequently presents to the emergency department. Although the diagnosis of KD is based on clinical criteria, children who do not fulfill the criteria but have sufficient supportive features of KD are diagnosed as having incomplete KD and warrant the same course of therapy as children with classic KD. The diagnosis of incomplete KD is challenging and requires a high index of suspicion. The purpose of this article is to review presenting features of incomplete KD and the diagnostic approach and management of children in the emergency department.
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Fabi M, Andreozzi L, Frabboni I, Dormi A, Corinaldesi E, Lami F, Cicero C, Tchana B, Francavilla R, Sprocati M, Bigucci B, Balsamo C, Valin PS, Di Fazzio G, Iughetti L, Valletta E, Marchetti F, Donti A, Lanari M. Non-coronary cardiac events, younger age, and IVIG unresponsiveness increase the risk for coronary aneurysms in Italian children with Kawasaki disease. Clin Rheumatol 2020; 40:1507-1514. [PMID: 32936425 DOI: 10.1007/s10067-020-05331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children in high-income countries because of coronary artery involvement. Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. METHODS Multicenter retrospective and prospective study including 372 consecutive children (58% boys; mean age 34.3 ± 30.3 months, Caucasian 85%) was diagnosed with KD. We divided the cohort into 2 groups according to the presence of coronary anomalies (CAA) and aneurysms. We compared the groups and studied the risk factors for CAA and for aneurysms, the most severe lesions. RESULTS Children with CAA were 91/372 (24.46%, aneurysms 20/372, 5.37%). Children with CAA were more likely to have a longer duration of fever (p < 0.001), later day of treatment (p < 0.001), to be IVIG non-responders and late treated (p < 0.001), while age, clinical presentation, and seasonality were not different. They also had significantly higher WBC and neutrophils, lower lymphocytes, Hb and Na during the acute stage, and slower resolution of inflammation. Age, IVIG unresponsiveness, and presence of non-coronary cardiac findings were independent risk factors for CAA and for aneurysms, while neutrophils just for CAA. Age under 6 months was a risk factor for the aneurysm. Aneurysms occurred more frequently in the first quartile of the age of KD onset (under 14 months). CONCLUSION Very young children with non-coronary cardiac findings are at increased risk for a more severe form of KD with aneurysms. These children could benefit from adjunctive therapy beside IVIG, especially if they have higher markers of inflammation, particularly neutrophils. Key points • Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. • Risk factors for coronary involvement have been extensively studied in the Asian population, and others have been validated in cohorts with mixed ethnicities. • In our predominantly Caucasian population, non-coronary cardiac findings, age younger than 6 months, and IVIG unresponsiveness are independent risk factors for a more severe form of KD with aneurysms.
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Affiliation(s)
- Marianna Fabi
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Laura Andreozzi
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Ilaria Frabboni
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Ada Dormi
- Department of Medical and Surgical Science, DIMEC, University of Bologna, Bologna, Italy
| | | | - Francesca Lami
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Cicero
- Department of Pediatrics, AUSL, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Bertrand Tchana
- Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma, Italy
| | | | - Monica Sprocati
- Department of Pediatrics, Arcispedale Sant'Anna, Ferrara, Italy
| | | | | | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Giorgia Di Fazzio
- Department of Pediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B.Morgagni - L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
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13
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Usefulness of Kawasaki disease risk scoring systems to the Turkish population. Anatol J Cardiol 2020; 24:97-106. [PMID: 32749248 PMCID: PMC7460684 DOI: 10.14744/anatoljcardiol.2020.37560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is the most common cause of coronary artery aneurysm (CAA) in children. The available risk scores to predict intravenous immunoglobulin (IVIG) resistance and CAA were developed in Asian populations in whom their effectiveness has been proven, but data on non-Asian children are limited. This study aimed to evaluate the ability of 5 risk scoring systems to predict IVIG resistance and CAA in Turkey patients with KD. METHODS Patients with KD were retrospectively evaluated with clinical, laboratory, and echocardiographic findings. Data analyses were performed in 5 scoring systems (Harada, Kobayashi, Egami, Formosa, and Sano). RESULTS A total of 259 patients (Male: Female, 1.7) were treated for KD in our hospital. The mean age of diagnosis in patients with KD, CAA, and IVIG resistance were 3.31, 2.19, and 2.06, respectively. CAA development and IVIG resistance were seen in 11.6% and 12.3% of cases, respectively. IVIG resistance was detected in 35.6% of patients with CAA. In our study, 5 risk scoring systems were applied to our patients. ROC analysis results were found highest in Kobayashi scoring system for IVIG resistance (AUC, 0.864) and in Harada scoring system for CAA development (AUC, 0.727). CONCLUSION Harada score was significant in predicting CAA risk, and Kobayashi score was significant in predicting the risk of developing IVIG resistance. It is necessary to determine more specific and sensitive risk scores that increase the risk of IVIG resistance and the development of CAA in Turkey.
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Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S, Danis K, Chomton M, Maurice L, Le Bourgeois F, Caseris M, Gaschignard J, Poline J, Cohen R, Titomanlio L, Faye A, Melki I, Meinzer U. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:662-668. [PMID: 32622376 PMCID: PMC7332278 DOI: 10.1016/s2352-4642(20)30175-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Background Kawasaki disease is an acute febrile systemic childhood vasculitis, which is suspected to be triggered by respiratory viral infections. We aimed to examine whether the ongoing COVID-19 epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an increase in the incidence of Kawasaki disease. Methods We did a quasi-experimental interrupted time series analysis over the past 15 years in a tertiary paediatric centre in the Paris region, a French epicentre of the COVID-19 outbreak. The main outcome was the number of Kawasaki disease cases over time, estimated by quasi-Poisson regression. In the same centre, we recorded the number of hospital admissions from the emergency department (2005–2020) and the results of nasopharyngeal multiplex PCR to identify respiratory pathogens (2017–2020). These data were compared with daily hospital admissions due to confirmed COVID-19 in the same region, recorded by Public Health France. Findings Between Dec 1, 2005, and May 20, 2020, we included 230 patients with Kawasaki disease. The median number of Kawasaki disease hospitalisations estimated by the quasi-Poisson model was 1·2 per month (IQR 1·1–1·3). In April, 2020, we identified a rapid increase of Kawasaki disease that was related to SARS-CoV-2 (six cases per month; 497% increase [95% CI 72–1082]; p=0·0011), starting 2 weeks after the peak of the COVID-19 epidemic. SARS-CoV-2 was the only virus circulating intensely during this period, and was found in eight (80%) of ten patients with Kawasaki disease since April 15 (SARS-CoV-2-positive PCR or serology). A second peak of hospital admissions due to Kawasaki disease was observed in December, 2009 (six cases per month; 365% increase ([31–719]; p=0.0053), concomitant with the influenza A H1N1 pandemic. Interpretation Our study further suggests that viral respiratory infections, including SAR-CoV-2, could be triggers for Kawasaki disease and indicates the potential timing of an increase in incidence of the disease in COVID-19 epidemics. Health-care providers should be prepared to manage an influx of patients with severe Kawasaki disease, particularly in countries where the peak of COVID-19 has recently been reached. Funding French National Research Agency.
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Affiliation(s)
- Naim Ouldali
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INSERM UMR 1123, ECEVE, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Marie Pouletty
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Patricia Mariani
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Constance Beyler
- Department of Pediatric Cardiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Blachier
- Department of Medical Information, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stephane Bonacorsi
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | | | - Maryline Chomton
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Le Bourgeois
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Gaschignard
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | - Julie Poline
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Center for Research on Inflammation, INSERM, UMR1149, Paris, France
| | - Robert Cohen
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Luigi Titomanlio
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Paediatric Emergency Care, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INSERM UMR 1123, ECEVE, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Isabelle Melki
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France; Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Paris, France
| | - Ulrich Meinzer
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Center for Research on Inflammation, INSERM, UMR1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France.
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15
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Tai IH, Wu PL, Guo MMH, Lee J, Chu CH, Hsieh KS, Kuo HC. Prognostic nutrition index as a predictor of coronary artery aneurysm in Kawasaki Disease. BMC Pediatr 2020; 20:203. [PMID: 32393306 PMCID: PMC7212668 DOI: 10.1186/s12887-020-02111-y] [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: 12/27/2019] [Accepted: 04/29/2020] [Indexed: 01/20/2023] Open
Abstract
Background Kawasaki Disease (KD) is considered a major acquired heart disease in children under the age of 5. Coronary artery aneurysm (CAA) can occur in serious cases despite extreme therapy efforts. Previous studies have reported low serum albumin level was associated with disease outcome, but no further investigation was addressed yet. Method This retrospective (case-control) study randomly included children with KD who were admitted and underwent laboratory tests before undergoing IVIG treatment in this institution, the largest tertiary medical center in southern Taiwan from 2012 to 2016. Prognostic nutrition index (PNI), an albumin-based formula product, was evaluated as a predictor of CAA the first time. The progression of CAA was monitored using serial echocardiography for six months. We performed multivariable logistic regression analysis on the laboratory test and PNI with the disease outcome of the KD patients. Result Of the 275 children, 149 had CAA, including transient dilatation, while the other 126 did not develop CAA during the 6-month follow-up period. A multivariate logistic regression model revealed that PNI, gender, IVIG non-responder, and platelet count are significant predictors of CAA with a 95% confidence interval estimator of 1.999, 3.058, 3.864 and 1.004, respectively. Using PNI to predict CAA presence gave an area under the receiver-operating-characteristics (ROC) curve of 0.596. For a cutoff of 0.5 in the logistic regression model and the PNI cut-off point is taken as 55 together with IVIG non-responder, boy gender, and platelet count take into account, sensitivity and specificity were 65.7 and 70.4%. Conclusion PNI could be a candidate of adjunctive predictor of coronary artery aneurysm in addition to IVIG non-responder. Together with low PNI, IVIG non-responder, male gender and platelet count will give high odds to predict coronary artery aneurysm within 6 months of illness.
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Affiliation(s)
- I-Hsin Tai
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan, College of Medicine, Chang Gung University, #123 Da-Pei Road, Niaosong District, Kaohsiung city, 83301, Taiwan.,Department of Pediatric Emergency China Medical University Children's Hospital, China Medical University, Taichung City, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Pei-Lin Wu
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan, College of Medicine, Chang Gung University, #123 Da-Pei Road, Niaosong District, Kaohsiung city, 83301, Taiwan
| | - Mindy Ming-Huey Guo
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan, College of Medicine, Chang Gung University, #123 Da-Pei Road, Niaosong District, Kaohsiung city, 83301, Taiwan
| | - Jessica Lee
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Chi-Hsiang Chu
- Department of Statistics, National Cheng Kung University, Tainan city, Taiwan
| | - Kai-Sheng Hsieh
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan, College of Medicine, Chang Gung University, #123 Da-Pei Road, Niaosong District, Kaohsiung city, 83301, Taiwan.,Department of Pediatrics, Shuang Ho Hospital-Taiwan Medical University, New Taipei City, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan, College of Medicine, Chang Gung University, #123 Da-Pei Road, Niaosong District, Kaohsiung city, 83301, Taiwan.
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16
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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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17
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Shao S, Luo C, Zhou K, Hua Y, Wu M, Liu L, Liu X, Wang C. The role of age-specific N-terminal pro-brain natriuretic peptide cutoff values in predicting intravenous immunoglobulin resistance in Kawasaki disease: a prospective cohort study. Pediatr Rheumatol Online J 2019; 17:65. [PMID: 31533770 PMCID: PMC6751871 DOI: 10.1186/s12969-019-0368-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prediction of resistance to intravenous immunoglobulins (IVIG) is currently still one of the main research areas in Kawasaki disease (KD). Several studies have reported on the use of N-terminal pro-brain natriuretic peptide (NT-ProBNP) to this end. However, considering the age-dependency of NT-ProBNP levels, age- specific NT-ProBNP cutoff levels to predict IVIG resistance in KD might be more precise and should be evaluated. METHODS A prospective cohort study with standardized data collection involving 393 KD patients aged 1 month to 125 months was conducted between June 2015 and April 2018. The demographic characteristics, clinical manifestations and laboratory data were compared between the patients responding to initial intravenous immunoglobulin (IVIG-response group) and those who did not (IVIG-resistance group). We further distinguished four subgroups according to patients' age (< 1 year, 1-2 years, 2-6 years, > 6 years). The cutoff values of NT-ProBNP for the prediction of IVIG resistance overall and in the subgroups were obtained using receiver operating characteristic (ROC) analysis. RESULTS In all KD patients, the level of NT-ProBNP was significantly higher in the IVIG-resistance compared to the IVIG-response group (P = 0.006). This findings was similar in the subgroups except for patients older than six years. The best cutoff values of NT-ProBNP to predict IVIG resistance were 3755 pg/ml for all KD patients, 3710 pg/ml, 2800 pg/ml, 2480 pg/ml for those aged 2-6 years, 1-2 years and < 1 year, respectively. The corresponding sensitivities were 44.0, 52.2, 50.0 and 75.0%, while the specifities were 84.1, 86.3, 77.9 and 71.8%, respectively. CONCLUSIONS NT-proBNP is a complementary laboratory marker for the prediction of IVIG resistance in KD patients, particularly for those younger than one year. Applying age-specific cutoff values is more precise than one value for all ages.
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Affiliation(s)
- Shuran Shao
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The 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
| | - Chunyan Luo
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, 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.
| | - Yimin Hua
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The 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 ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China ,0000 0001 0807 1581grid.13291.38Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Mei Wu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The 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
| | - Lei Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The 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
| | - Xiaoliang Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The 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 ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, 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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Grignani R, Rajgor DD, Leow YG, Heng CK, Quek SC. A novel model for predicting non-responsiveness to intravenous immunoglobulins in Kawasaki disease: The Singapore experience. J Paediatr Child Health 2019; 55:962-967. [PMID: 30520192 DOI: 10.1111/jpc.14329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
AIM We aimed to assess the utility of four published risk-scoring methods in predicting intravenous immunoglobulins (IVIG) non-responsiveness in Kawasaki disease (KD) patients from Singapore and develop a new predictive model. METHODS We reviewed the medical records of 215 KD children. The performance of existing scoring methods in identifying non-responsive cases based on sensitivities (SN) and specificities (SP) was evaluated in 122 Singaporean Chinese. From our dataset, a model involving six predictors was built. RESULTS The following respective SN (%) and SP (%) were obtained: Egami: 26%, 68%; Kobayashi: 21%, 62%; Sano: 13%, 86% and Fukunishi: 46%, 71%. These results indicated that the existing scoring methods performed poorly compared to those reported in their respective original publications, which ranged between 68 and 87%. The new predictive model was derived with an improved SN (80%) and SP (80%). CONCLUSIONS Currently available risk-scoring methods have less applicability in the Singaporean Chinese population. The proposed new risk-scoring predictive model derived based on data from Chinese cohort demonstrated much better SN and SP.
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Affiliation(s)
- Robert Grignani
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore.,Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Dimple D Rajgor
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao-Guang Leow
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chew-Kiat Heng
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swee-Chye Quek
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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The factors affecting the disease course in Kawasaki disease. Rheumatol Int 2019; 39:1343-1349. [PMID: 31139951 DOI: 10.1007/s00296-019-04336-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/23/2019] [Indexed: 12/18/2022]
Abstract
The aim of this study was to review the characteristics of patients with Kawasaki disease (KD) from Turkey and to assess the performance of the Kobayashi score (KS), Harada score (HS), Formosa score (FS), Egami score (ES) and other parameters in predicting intravenous immunoglobulin (IVIG) resistance and coronary artery involvement (CAI) in the Turkish population. Patients who were diagnosed as being in the acute phase of KD at Hacettepe University Faculty of Medicine (Ankara, Turkey) between June 2007 and January 2016 reviewed retrospectively, and those between January 2016 and February 2018 reviewed prospectively, were included in this cohort study. A total of 100 patients with KD were included in this study. Statistical Package for Social Sciences for Windows 22.0 (SPSS Inc, Chicago, IL, USA) was used for statistical analysis. Eighty-five patients (85%) responded to IVIG treatment, whereas 15 (5 female, 10 male) were IVIG resistant. CAI was detected in echocardiography at diagnosis in 31 (31%) (9 female; 22 male) patients. For predicting IVIG resistance, KS, ES, FS, and HS had sensitivity of 82.1%, 26.7%, 30.8%, 69.2% and specificity of 35.7%, 94%, 51.2%, 45.8%, respectively. For the association with CAI occurrence, the sensitivities were 17.2%, 3.3%, 35.7%, 70.4% and the specificities were 78.5%, 88.4%, 49.3%, 49.3% for the aforementioned scores, respectively. The multivariate analysis showed white blood cell (WBC) count [Odd's ratio (OR) 4.1; 95% confidence interval (CI) 1.26-13.23; p = 0.019] and hematocrit (OR 3.8; 95% CI 1.15-12.4; p = 0.028), as independent predictors of CAI while gamma-glutamyl transferase (GGT) level (OR 5.7; 95% CI 1.73-27.51; p = 0.018) was detected as the only independent predictor of IVIG resistance. This is the first study from Turkey in KD to evaluate the association of the scoring systems for IVIG resistance and CAI. The risk scoring systems in KD did not predict the risk for IVIG resistance and were not associated with CAI in Turkish population.
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Fabi M, Andreozzi L, Corinaldesi E, Bodnar T, Lami F, Cicero C, Tchana B, Landini C, Sprocati M, Bigucci B, Balsamo C, Sogno Valin P, Di Fazzio G, Iughetti L, Valletta E, Marchetti F, Donti A, Lanari M. Inability of Asian risk scoring systems to predict intravenous immunoglobulin resistance and coronary lesions in Kawasaki disease in an Italian cohort. Eur J Pediatr 2019; 178:315-322. [PMID: 30499051 DOI: 10.1007/s00431-018-3297-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022]
Abstract
Since resistance to intravenous immunoglobulin (IVIG) is associated with coronary lesions (CALs) in Kawasaki disease (KD), it is crucial to identify patients at risk to protect them from coronary involvement. The available risk scores to predict IVIG resistance were developed in Asian populations in whom their effectiveness has been proven, but data on non-Asian children are limited. The aim of this study is to evaluate the ability of the Kobayashi, Egami, and Formosa risk scores to predict IVIG resistance and CALs in Italian patients with KD. A multicenter retrospective analysis involving children with KD diagnosed between 2000 and 2015 was carried out: 257 patients were enrolled (57.9% boys, 89.9% Caucasian); 43 patients were IVIG resistant (16.7%). The scores have low sensitivity and specificity in predicting IVIG resistance: respectively, KS 64% and 62.5%, ES 41.4% and 77.4%, and FS 70.8% and 44.9%. The predictive value of the 3 scores for predicting CALs was also poor.Conclusion: Kobayashi, Egami, and Formosa Scores are ineffective in predicting IVIG resistance and coronary involvement in a predominantly Caucasian cohort. A specific score system for mostly Caucasian children with KD is needed enable the early identification of those at risk for CALs who could benefit from intensified treatment. What is Known: • There are several risk scores developed in the Asian population to early identify patients with KD at risk for immunoglobulin-resistance and thus for coronary lesions. • Data are scarce on their effectiveness in non-Asian children. What is New: • We present a comprehensive analysis of the ability of 3 Asian risk scores in a cohort of mostly Caucasian children to predict immunoglobulin resistance and coronary involvement. • Low sensitivity and specificity of the Asian scores for immunoglobulin-resistance and coronary lesions suggest the need for criteria specific for different ethnicities.
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Affiliation(s)
- Marianna Fabi
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Laura Andreozzi
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | | | - Tetyana Bodnar
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesca Lami
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Cicero
- Department of Pediatrics, AUSL, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Bertrand Tchana
- Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma, Italy
| | - Chiara Landini
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | - Monica Sprocati
- Department of Pediatrics, Arcispedale Sant'Anna, Ferrara, Italy
| | | | | | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Giorgia Di Fazzio
- Department of Pediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B.Morgagni - L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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Predictors of Intravenous Immunoglobulin Nonresponse and Racial Disparities in Kawasaki Disease. Pediatr Infect Dis J 2018; 37:1227-1234. [PMID: 29570178 DOI: 10.1097/inf.0000000000002019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is the most common cause of acquired heart disease in American children. Intravenous immunoglobulin (IVIG) nonresponse is a known risk factor for cardiac sequelae. Previously reported risk factors for nonresponse include age, male sex and laboratory abnormalities. We set out to identify additional risk factors for IVIG nonresponse in a racially diverse KD population. METHODS We conducted a retrospective chart review at a referral center in the Southeastern United States of children meeting ICD-9 (International Statistical Classification of Disease and Related Health Problems) criteria for KD and being treated with IVIG. RESULTS Four-hundred and fifty-nine children met inclusion criteria, 67 were excluded for subsequent rheumatologic diagnosis, unknown race, or failure to meet the American Heart Association guideline criteria. Our final cohort consisted of 392 subjects, with median age of 2.7 years, 65.1% male, 66.1% White, 24.2% Black, 4.9% Asian and 82.9% responded to a single dose of IVIG. Coronary ectasia or aneurysm developed in 27%; 7.4% developed aneurysms and 2.3% giant coronary aneurysms. Nonresponders were more likely to be Black, have higher white blood cell, erythrocyte sedimentation rate and C-reactive protein, lower hemoglobin, develop ectasia or aneurysm and require critical care and hospital readmission. Responders achieved echocardiographic normalization more often compared with nonresponders (81.3% vs. 60.9%, P = 0.002) and coronary artery pseudonormalization (87.2% vs. 69.7%, P = 0.03) at 1 year. Black nonresponders had the slowest normalization at 1 year (52.9%, P = 0.02). CONCLUSIONS Nonresponders have higher rates and greater severity of coronary involvement than responders. Our study uniquely demonstrates Black race as a risk factor for nonresponse and for delayed normalization of cardiac involvement at 1-year follow-up.
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Failure to Predict High-risk Kawasaki Disease Patients in a Population-based Study Cohort in Germany. Pediatr Infect Dis J 2018; 37:850-855. [PMID: 29406464 DOI: 10.1097/inf.0000000000001923] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diverse scores on high-risk Kawasaki disease (KD) patients have proven a good prognostic validity in the Japanese population. However, data on non-Japanese have been inconclusive. Do the Kobayashi, Egami and Sano scores or application of up-to-date statistical methods (Random Forest) predict response to standard intravenous immunoglobulin (IVIG) therapy and the risk of persistent coronary artery aneurysm (CAA) in patients with KD in a mainly Caucasian population in Germany? METHODS Data on 442 children (German population-based survey, 2013 and 2014) were used to assess the prognostic validity of the Kobayashi, Egami and Sano scores for being refractory to IVIG treatment and for predicting the risk of persistent CAA. Additionally, an up-to-date statistical approach (Random Forest) was applied to identify a potentially more valid score. RESULTS A total of 301 children were eligible for assessment of their response to IVIG treatment. Among those, 177 children were followed-up for 1 year to identify persistent CAA. Although all scores were significantly associated with being refractory to IVIG (relative risk range between 2.32 and 3.73), the prognostic properties were low (likelihood ratio positive: 1.83-4.57; sensitivity in the range of 0.28-0.53). None of the scores was a significant predictor of CAA 1 year after acute illness. Application of statistical analysis such as Random Forest did not yield a more valid score. CONCLUSIONS None of the available scores appears to be appropriate for identifying high-risk Caucasian children with KD who might need intensified therapy.
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Chbeir D, Gaschignard J, Bonnefoy R, Beyler C, Melki I, Faye A, Meinzer U. Kawasaki disease: abnormal initial echocardiogram is associated with resistance to IV Ig and development of coronary artery lesions. Pediatr Rheumatol Online J 2018; 16:48. [PMID: 30021610 PMCID: PMC6052519 DOI: 10.1186/s12969-018-0264-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile systemic vasculitis that affects small and medium blood vessels. Intensified treatments for the most severely affected patients have been proposed recently, and the early identification of KD patients at high risk for coronary artery aneurysms (CAA) is crucial. However, the risk scoring systems developed in Japan have not been validated in European populations, and little data is available concerning the link between initial echocardiogram findings other than high z-scores and cardiac prognosis. METHODS In order to investigate whether the presence of any abnormalities, other than high z-scores in first echocardiogram, are associated with resistance to IV immunoglobulins and/or subsequent development of CAA, we retrospectively analyzed data from children diagnosed with KD between 2006 and 2016 at a tertiary Hospital in Paris, France. RESULTS A total of 157 children were included. The initial echocardiogram was performed after a median of 7 days of fever and was abnormal in 48 cases (31%). The initial presence of any echocardiographic abnormality (coronary artery dilatation, CAA, pericardial effusion, perivascular brightness of the coronary arteries, left-ventricular dysfunction and mitral insufficiency) was strongly associated with resistance to intravenous immunoglobulin (p = 0.005) and development of coronary artery lesions within the first 6 weeks of disease (p = 0.01). All patients (n = 7) with persistent coronary abnormalities at 1 year already had an abnormal initial echocardiogram. Severity scoring systems from Japan had low sensitivity (0-33%) and low specificity (71-82%) for predicting immunoglobulin resistance or cardiac involvement. CONCLUSIONS In European populations with mixed ethnic backgrounds, the presence of any abnormalities at the initial echocardiogram may contribute to early identification of patients with severe disease.
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Affiliation(s)
- Dima Chbeir
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Jean Gaschignard
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Ronan Bonnefoy
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
| | - Constance Beyler
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
| | - Isabelle Melki
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Albert Faye
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Ulrich Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Institut Pasteur, Unité biologie et génétique de la paroi bactérienne, 75015 Paris, France
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Abstract
Despite the administration of intravenous immunoglobulin (IVIg) at a dose of 2 g/kg, approximately 3-5% of children with acute Kawasaki disease (KD) may develop coronary artery aneurysms. IVIg-resistance, defined as recrudescence of fever more than 36 h after IVIg completion, is a risk factor for coronary artery abnormalities. Thus, several adjunctive therapies are being evaluated for use in IVIg-resistant KD patients and in patients with coronary artery abnormalities. In this review the role of some of these adjunctive therapies in treatment of children with KD is discussed.
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Affiliation(s)
- Adriana H Tremoulet
- Kawasaki Disease Research Center, University of California San Diego, La Jolla, CA, USA
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Li X, Chen Y, Tang Y, Ding Y, Xu Q, Sun L, Qian W, Qian G, Qin L, Lv H. Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a meta-analysis of 4442 cases. Eur J Pediatr 2018; 177:1279-1292. [PMID: 29948255 PMCID: PMC6061038 DOI: 10.1007/s00431-018-3182-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ≤ 4.0 days after the onset of symptoms were more likely to be IVIG resistant. CONCLUSION The initial administration of IVIG ≤ 4.0 days after the onset of symptoms increased ESR and decreased hemoglobin and platelet counts, oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, and polymorphous rash and are the risk factors for IVIG-resistant Kawasaki disease. What is Known: • Recent reports on this topic are about aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase, total bilirubin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), polymorphonuclear leukocytes (PMN), C-reactive protein (CRP), pro-brain natriuretic peptide (BNP), albumin, and sodium as the risk factors in the IVIG-resistant Kawasaki disease; however, no studies have been published on clinical features as predictors of IVIG resistance. What is New: • This meta-analysis identified the clinical features, the initial administration of IVIG ≤ 4.0 days after the onset of symptoms, and much more comprehensive laboratory indicators, such as hemoglobin, as predictors of IVIG-resistant Kawasaki disease.
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Affiliation(s)
- Xuan Li
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Ye Chen
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yunjia Tang
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yueyue Ding
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Qiuqin Xu
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Lin Sun
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Weiguo Qian
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Guanghui Qian
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, 215003, China.
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Takeuchi M, Inuzuka R, Hayashi T, Shindo T, Hirata Y, Shimizu N, Inatomi J, Yokoyama Y, Namai Y, Oda Y, Takamizawa M, Kagawa J, Harita Y, Oka A. Novel Risk Assessment Tool for Immunoglobulin Resistance in Kawasaki Disease: Application Using a Random Forest Classifier. Pediatr Infect Dis J 2017; 36:821-826. [PMID: 28441265 DOI: 10.1097/inf.0000000000001621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Resistance to intravenous immunoglobulin (IVIG) therapy is a risk factor for coronary lesions in patients with Kawasaki disease (KD). Risk-adjusted initial therapy may improve coronary outcome in KD, but identification of high risk patients remains a challenge. This study aimed to develop a new risk assessment tool for IVIG resistance using advanced statistical techniques. METHODS Data were retrospectively collected from KD patients receiving IVIG therapy, including demographic characteristics, signs and symptoms of KD and laboratory results. A random forest (RF) classifier, a tree-based machine learning technique, was applied to these data. The correlation between each variable and risk of IVIG resistance was estimated. RESULTS Data were obtained from 767 patients with KD, including 170 (22.1%) who were refractory to initial IVIG therapy. The predictive tool based on the RF algorithm had an area under the receiver operating characteristic curve of 0.916, a sensitivity of 79.7% and a specificity of 87.3%. Its misclassification rate in the general patient population was estimated to be 15.5%. RF also identified markers related to IVIG resistance such as abnormal liver markers and percentage neutrophils, displaying relationships between these markers and predicted risk. CONCLUSIONS The RF classifier reliably identified KD patients at high risk for IVIG resistance, presenting clinical markers relevant to treatment failure. Evaluation in other patient populations is required to determine whether this risk assessment tool relying on RF has clinical value.
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Affiliation(s)
- Masato Takeuchi
- From the *Department of Pediatrics, Kikkoman General Hospital, Chiba, Japan; †Department of Pediatrics, The University of Tokyo, Tokyo, Japan; ‡Department of Pediatrics, Yaizu City Hospital, Shizuoka, Japan; §Department of Pediatrics, Ome Municipal Hospital, Tokyo, Japan; ¶Department of Pediatrics, Ohta-Nishinouchi Hospital, Fukushima, Japan; ‖Department of Pediatrics, Chigasaki Municipal Hospital, Kanagawa, Japan; **Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan; and ††Department of Pediatrics, Fujieda Municipal General Hospital, Shizuoka, 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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Engelberg R, Martin M, Wrotniak BH, Hicar MD. Observational study of Interleukin-21 (IL-21) does not distinguish Kawasaki disease from other causes of fever in children. Pediatr Rheumatol Online J 2017; 15:32. [PMID: 28427414 PMCID: PMC5397673 DOI: 10.1186/s12969-017-0163-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a febrile childhood vasculitis of unknown etiology. The diagnosis is highly concerning as over a quarter of children who fail to receive timely treatment with intravenous immunoglobulin (IVIG) will develop coronary aneurysms. Diagnosis relies on proper symptomatology and is supported by non-specific markers of inflammation. Previous studies have identified elevated plasma levels of interleukin-21 (IL-21) as a sensitive and specific biomarker in KD. The aim of this study is to assess the validity of IL-21 as a diagnostic biomarker for KD in febrile children in North America. METHODS Plasma samples were collected from children who presented to an urban Emergency Department in North America. IL-21 levels were measured using commercial ELISA kits in 12 KD versus 60 controls subjects. RESULTS Our study shows that IL-21 levels were non-specifically elevated across all febrile children, irrespective of KD diagnosis. Length of fever prior to sample collection does not correlate with IL-21 levels. Other inflammatory markers and laboratory values were also compared to IL-21 and show no significant correlation. CONCLUSIONS Since IL-21 is elevated non-specifically in this cohort, our data supports that IL-21 is not an appropriate biomarker for diagnosis of KD in North American pediatric populations.
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Affiliation(s)
- Rachel Engelberg
- 0000 0004 1936 9887grid.273335.3Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY USA
| | - Meghan Martin
- 0000 0004 1936 9887grid.273335.3Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY USA ,0000 0004 1936 9887grid.273335.3Department of Pediatrics, University at Buffalo, Buffalo, NY USA
| | - Brian H. Wrotniak
- 0000 0004 1936 9887grid.273335.3Department of Pediatrics, University at Buffalo, Buffalo, NY USA
| | - Mark Daniel Hicar
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. .,Department of Pediatrics, University at Buffalo, Buffalo, NY, USA.
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29
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Dietz SM, Kuipers IM, Tacke CEA, Koole JCD, Hutten BA, Kuijpers TW. Giant aneurysms: A gender-specific complication of Kawasaki disease? J Cardiol 2017; 70:359-365. [PMID: 28325522 DOI: 10.1016/j.jjcc.2016.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/21/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a pediatric vasculitis of unknown origin. Its main complication is the development of coronary artery aneurysms (CAA) with giant CAA at the end of the spectrum. METHODS In this cohort study, we evaluated the association between patient characteristics and the development of giant CAA based on z-scores. Multivariable, multinomial logistic regression analysis was used to identify variables associated with giant CAA. RESULTS A total of 301 KD patients, comprising 216 patients without enlargement, 45 with small-sized, 19 with medium-sized, and 21 with giant CAA with all echocardiographies at our center were retrospectively included. Remarkably, 95% of patients with giant CAA were boys. In addition to 'no/late intravenous immunoglobulin (IVIG) treatment', 'male gender' (OR 16.23, 95% CI 1.88-140.13), 'age<1 year' (OR 7.49, 95% CI 2.29-24.46), and 'IVIG re-treatment (9.79, 95% CI 2.79-34.37)' were significantly associated with an increased risk of giant CAA, with patients without enlargement as reference. Compared to patients with medium-sized CAA, 'IVIG re-treatment' was significantly associated with giant CAA. The majority of giant CAA continued to increase in size during the first 40 days. CONCLUSIONS We identified risk factors associated with an increased risk of giant CAA. The difference in variables between the giant CAA group and the other CAA subgroups suggests a separation between patients with the treatment-resistant giant CAA and the other IVIG-responsive patients, in which gender may be factored as a most relevant genetic trait. The increase in size during the first 2 months indicates the need for repeated echocardiography.
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Affiliation(s)
- Sanne M Dietz
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Carline E A Tacke
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jeffrey C D Koole
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Barbara A Hutten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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30
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Dissecting Kawasaki disease: a state-of-the-art review. Eur J Pediatr 2017; 176:995-1009. [PMID: 28656474 PMCID: PMC5511310 DOI: 10.1007/s00431-017-2937-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. The diagnosis is based on the presence of persistent fever and clinical features including exanthema, lymphadenopathy, conjunctival injection, and changes to the mucosae and extremities. Although the etiology remains unknown, the current consensus is that it is likely caused by an (infectious) trigger initiating an abnormal immune response in genetically predisposed children. Treatment consists of high dose intravenous immunoglobulin (IVIG) and is directed at preventing the development of CAA. Unfortunately, 10-20% of all patients fail to respond to IVIG and these children need additional anti-inflammatory treatment. Coronary artery lesions are diagnosed by echocardiography in the acute and subacute phases. Both absolute arterial diameters and z-scores, adjusted for height and weight, are used as criteria for CAA. Close monitoring of CAA is important as ischemic symptoms or myocardial infarction due to thrombosis or stenosis can occur. These complications are most likely to arise in the largest, so-called giant CAA. Apart from the presence of CAA, it is unclear whether KD causes an increased cardiovascular risk due to the vasculitis itself. CONCLUSION Many aspects of KD remain unknown, although there is growing knowledge on the etiology, treatment, and development and classification of CAA. Since children with previous KD are entering adulthood, long-term follow-up is increasingly important. What is known: • Kawasaki disease (KD) is a pediatric vasculitis with coronary artery damage as its main complication. • Although KD approaches its 50th birthday since its first description, many aspects of the disease remain poorly understood. What is new: • In recent years, multiple genetic candidate pathways involved in KD have been identified, with recently promising information about the ITPKC pathway. • As increasing numbers of KD patients are reaching adulthood, increasing information is available about the long-term consequences of coronary artery damage and broader cardiovascular risk.
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Kawasaki disease in Sicily: clinical description and markers of disease severity. Ital J Pediatr 2016; 42:92. [PMID: 27806720 PMCID: PMC5094032 DOI: 10.1186/s13052-016-0306-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 10/21/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis of small and middle size arteries; 15-25 % of untreated patients and 5 % of patients treated with intravenous immunoglobulin (IVIG) develop coronary artery lesions (CAL). Many studies tried to find the most effective treatment in the management of resistant KD and to select the risk factors for CAL. Our data are assessed on children from west Sicily, characterized by a genetic heterogeneity. METHODS We studied the clinical data of 70 KD Sicilian children (36 males: 51 %; 34 females: 49 %), analysed retrospectively, including: demographic and laboratory parameters; echocardiographic findings at diagnosis, at 2, 6 and 8 weeks, and at 1 year after the onset of the illness. RESULTS Forty-seven had Typical KD, three Atypical KD and twenty Incomplete KD. Age at the disease onset ranged from 0.1 to 8.9 years. IVIG were administered 5 ± 2 days after the fever started. Defervescence occurred 39 ± 26 hours after the first IVIG infusion. Fifty-six patients (80 %) received 1 dose of IVIG (responders); 14 patients (20 %) had a resistant KD, with persistent fever after the first IVIG dose (non responders). Ten (14 %) non responders responded to the second dose, 4 (5 %) responded to three doses; one needed treatment with high doses of steroids and Infliximab. Cardiac involvement was documented in twenty-two cases (eighteen with transient dilatation/ectasia, fifteen with aneurysms). Pericardial effusion, documented in eleven, was associated with coronaritis and aneurysms, and was present earlier than coronary involvement in seven. Hypoalbuminemia, D-dimer pre-IVIG, gamma-GT pre-IVIG showed a statistically significant direct correlation with IVIG doses, highlighting the role of these parameters as predictor markers of refractory disease. The persistence of elevated CRP, AST, ALT levels, a persistent hyponatremia and hypoalbuminemia after IVIG therapy, also had a statistical significant correlation with IVIG doses. Non responders showed higher levels of D-dimer and gamma-GT pre-IVIG, persistent high levels of D-dimer, CRP, AST, ALT, hypoalbuminemia and hyponatremia after IVIG. CONCLUSIONS This is the first study on KD in Sicily. We suggest some laboratory parameters as predictive criteria for resistant KD. Patients who show early pericarditis need careful surveillance for coronary lesions.
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Sánchez-Manubens J, Antón J, Bou R, Iglesias E, Calzada-Hernandez J, Borlan S, Gimenez-Roca C, Rivera J. Role of the Egami score to predict immunoglobulin resistance in Kawasaki disease among a Western Mediterranean population. Rheumatol Int 2016; 36:905-10. [DOI: 10.1007/s00296-016-3499-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Kibata T, Suzuki Y, Hasegawa S, Matsushige T, Kusuda T, Hoshide M, Takahashi K, Okada S, Wakiguchi H, Moriwake T, Uchida M, Ohbuchi N, Iwai T, Hasegawa M, Ichihara K, Yashiro M, Makino N, Nakamura Y, Ohga S. Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin. Int J Cardiol 2016; 214:209-15. [PMID: 27070994 DOI: 10.1016/j.ijcard.2016.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/12/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUNDS Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. METHODS Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24months). RESULTS The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7% to 23% during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0%) was higher than that in those who did not (14/1450; 0.97%, p=2.0×10(-35)). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7% vs. 5/194; 2.6%, p=8.9×10(-10)). Multivariate analyses indicated corticosteroid therapy (p<0.0001), hyperbilirubinemia (p=0.0010), and a longer number of days before treatment (p=0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. CONCLUSIONS IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.
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Affiliation(s)
- Tetsuhiro Kibata
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan.
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takeshi Kusuda
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Madoka Hoshide
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazumasa Takahashi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tadashi Moriwake
- Division of Pediatrics, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Masashi Uchida
- Division of Pediatrics, JCHO Tokuyama Central Hospital, Shunan, Japan
| | - Noriko Ohbuchi
- Division of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Takashi Iwai
- Division of Pediatrics, Yamaguchi-ken Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | | | - Kiyoshi Ichihara
- Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
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