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Chen X, Gao L, Zhen Z, Wang Y, Na J, Yu W, Tian Z, Yuan Y, Qian S. Incidence of coronary artery lesions in children with recurrent Kawasaki disease. Expert Rev Clin Immunol 2024; 20:673-678. [PMID: 38315096 DOI: 10.1080/1744666x.2024.2314213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Coronary artery lesions (CALs) are a major complication of Kawasaki disease (KD); however, data on CAL incidence and risk factors in recurrent KD are limited. METHODS Ninety-seven children with recurrent KD were retrospectively enrolled from 2013 to 2022, and CAL incidence was tracked during admission, discharge, and during follow-up. RESULTS Initially, 27.8% had CAL at admission and discharge, declining to 7.2% at 12 months post-discharge. Most patients (66 of 97, 68.0%) did not exhibit CAL at any of the time points, 7 cases presented CAL at all time points, indicating a persistent CAL. The remaining 20 cases presented CAL at admission but recovered at discharge or during follow-up. Notably, transient CALs had presented at discharge, or during the follow-up, but finally resolved at 12 months after discharge. Notably, prior IVIG resistance and increased prothrombin time seemed associated with CAL in recurrent KD, suggesting they could help identify patients needing close monitoring. CONCLUSION The study highlights decreasing CAL incidence over time in recurrent KD but with diverse patterns, emphasizing the importance of monitoring and further investigations to confirm these findings.
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Affiliation(s)
- Xi Chen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lu Gao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Wang
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jia Na
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wen Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyu Tian
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Zhang Y, Liu J. Clinical value of echocardiography combined with serum Cav-1, NFATc1, and PAI-1 in the diagnosis of Kawasaki disease complicated with coronary artery lesions. Heart Vessels 2024; 39:18-24. [PMID: 37758852 DOI: 10.1007/s00380-023-02315-z] [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: 05/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
To analyze the clinical value of echocardiography combined with serum lacuna protein-1 (Cav-1), activated T cell nuclear factor C1 (NFATc1), and plasminogen activator inhibitor-1 (PAI-1) in the diagnosis of Kawasaki disease (KD) complicated with coronary artery lesions (CAL). A total of 200 children with KD treated in our hospital from January 2019 to October 2021 were grouped as the KD alone group (n = 56) and the KD complicated with CAL group (n = 144) according to the results of coronary angiography. The levels of Cav-1, NFATc1, and PAI-1 were detected by enzyme-linked immunosorbent assay. Echocardiography was performed and the internal diameters of left and right coronary arteries were compared between the two groups. The area under the curve (AUC), sensitivity, and specificity of echocardiography combined with serum Cav-1, NFATc1, and PAI-1 in the diagnosis of KD complicated with CAL were analyzed with receiver operating characteristic (ROC) curve. Coronary angiography, as the gold standard, showed that the sensitivity of echocardiography in diagnosing KD with CAL was 88.19% (127/144), the specificity was 66.07% (37/56), and the accuracy was 82.00% (164/200). ROC curve analysis revealed that the AUC of KD complicated with CAL diagnosed by echocardiography, Cav-1, NFATc1, and PAI-1 was 0.819, 0.715, 0.688, and 0.663, respectively, and the AUC of combined diagnosis of the four was 0.896. The combination of echocardiography, Cav-1, NFATc1, and PAI-1 has high value in diagnosing KD complicated with CAL, which can be widely used in clinical practice.
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Affiliation(s)
- Yanxia Zhang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, Shanxi, China
| | - Jieqiong Liu
- Department of Ultrasonography, Children's Hospital of Shanxi Province (Shanxi Maternal and Child Health Care Hospital), Taiyuan, 030013, Shanxi, China.
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Duan Y, Li H, Luo D, Jiang J, Liu B, Li G. Serum IL-41 might be a biomarker for IVIG resistance and coronary artery lesions in Kawasaki disease. Int Immunopharmacol 2023; 122:110600. [PMID: 37423157 DOI: 10.1016/j.intimp.2023.110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/11/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aimed to evaluate serum IL-41 levels in IVIG resistance and CALs, and to elucidate the relationship between IL-41 and Kawasaki disease (KD)-related clinical parameters. METHODS 93 children with KD were collected. Baseline clinical data were obtained by physical examination. Serum IL-41 levels were detected with an enzyme-linked immunosorbent assay. The correlations between IL-41 and the clinical parameter of KD were performed by Spearman correlation coefficient. Receiver operating characteristic curve analysis was performed to assess the predictive ability of IL-41 for IVIG resistance and CALs. RESULTS Serum IL-41 levels were significantly increased in the IVIG resistance group compared with the response group, and serum IL-41 levels in the CALs group were higher than those in the non-CALs group. Serum IL-41 levels were positively correlated with erythrocyte sedimentation rate, C-reactive protein and C-reactive protein/albumin ratio, but negatively correlated with albumin. Serum IL-41 levels was an independent risk factor for CALs, and total fever days and neutrophil-to-lymphocyte ratio (NLR) were independent predictors for IVIG resistance. The area under the curve (AUC) value for serum IL-41 to predict IVIG resistance was 0.73, yielding a sensitivity of 54.55% and a specificity of 81.71%. The AUC of serum IL-41 was 0.712, with a sensitivity of 63.16% and a specificity of 72.97% for predicting CALs. IL-41 was not inferior to NLR in predicting IVIG resistance (z = 0.282, p = 0.7783). CONCLUSIONS Serum IL-41 was increased in IVIG resistance and CALs. Serum IL-41 might be a new potential biomarker for IVIG resistance and CALs.
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Affiliation(s)
- Yan Duan
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Hui Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Dinghua Luo
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Jun Jiang
- Department of General Surgery (Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, China
| | - Bin Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
| | - Gang Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
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Differences in Sensitivity Between the Japanese and Z Score Criteria for Detecting Coronary Artery Abnormalities Resulting from Kawasaki Disease. Pediatr Cardiol 2023; 44:153-160. [PMID: 36121493 DOI: 10.1007/s00246-022-03008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
No studies have assessed differences between the Japanese and Z score criteria in the echocardiographic detection sensitivity of coronary artery (CA) abnormalities using large-scale data containing samples from multiple facilities engaged in daily clinical practices of Kawasaki disease (KD). We analyzed data from the 25th Japanese nationwide KD survey, which identified 30,415 patients from 1357 hospitals throughout Japan during 2017-2018. Hospitals were classified according to their use of Z score criteria. We assessed differences in hospital and patient background factors and compared the prevalence of CA abnormalities among groups using the Z score criteria. Multivariable logistic regression analyses were performed to evaluate differences in the detection sensitivity for CA abnormalities. The Z score criteria were more likely to be utilized in larger hospitals with more pediatricians and cardiologists. Even after controlling for potential confounders, detection sensitivities by the Z score criteria were significantly higher than by the Japanese criteria in patients with CA dilatations (adjusted odds ratio (95% confidence interval) 1.77 (1.56-2.01)) and aneurysms (1.62 (1.17-2.24)). No significant difference was found in patients with giant CA aneurysms. Compared with the Japanese criteria, the Z score criteria were significantly more sensitive for detecting patients with CA dilatations regardless of age, and for those with CA aneurysms only in patients aged ≤ 1 year. Our results indicate that differences in the detection sensitivity for CA abnormalities between the Z score and the Japanese criteria were dependent on the CA size and patient age.
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Liu J, Huang Y, Qin S, Su D, Ye B, Pang Y. Extracardiovascular injury complications in Kawasaki disease. Pediatr Investig 2022; 6:241-249. [PMID: 36582273 PMCID: PMC9789935 DOI: 10.1002/ped4.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
Importance Patients with Kawasaki disease (KD) experience various extracardiovascular injury complications, which may affect their outcomes. Objective To investigate the incidence and clinical characteristics of extracardiovascular complications in children with KD. Methods The clinical data of patients diagnosed with KD in the First Affiliated Hospital of Guangxi Medical University from January 2003 to January 2021 were reviewed. The clinical characteristics and extracardiovascular complications were compared among patients stratified by age, intravenous immunoglobulin (IVIG) therapy responsiveness, and coronary status. Results A total of 511 patients with KD were included, 357 (69.9%) were aged 1-5 years. Children aged <1 year (21.5%) and boys (70.8%) were more likely to have coronary artery lesions (CALs). The incidence of incomplete KD was lowest in 1-5-year-old patients (19.6%). Involvement of the hematological system gradually decreased with age (<1 year, 51.8%; 1-5 years, 36.7%; >5 years, 29.5%), whereas the involvement of the joints gradually increased with age (<1 year, 2.7%; 1-5 years, 6.2%; >5 years, 20.5%). Nervous system involvement was more common in IVIG non-responders (15.7% [13/83] vs. 5.4% [23/428], P = 0.001). However, there were no significant differences in extracardiovascular injury complications between patients with or without CALs. Interpretation KD can involve multiple organ injuries as well as cardiovascular complications, and nervous systerm involvement may be more common in patients unresponsive to IVIG.
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Affiliation(s)
- Jie Liu
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Yuqin Huang
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Suyuan Qin
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Danyan Su
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Bingbing Ye
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Yusheng Pang
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
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Lee W, Cheah CS, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (B Aires) 2022; 58:medicina58060734. [PMID: 35743997 PMCID: PMC9227912 DOI: 10.3390/medicina58060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Kawasaki disease (KD) has shown a marked increase in trend over the globe, especially within the last two decades. Kawasaki disease is often seen in the paediatric population below five years old, while it is rare for those who are beyond that age. Up to this date, no exact causes has been identified although KD was found more than half a century ago. The underlying pathogenesis of the disease is still unelucidated, and researchers are trying to unlock the mystery of KD. To further complicate the diagnosis and the prompt management, a specific biomarker for the diagnosis of KD is yet to be discovered, making it hard to differentiate between KD and other diseases with a similar presentation. Nonetheless, since its discovery, clinicians and scientists alike had known more about the different clinical aspects of typical KD. Thus, this article intends to revisit and review the various clinical manifestations and laboratory characteristics of KD in order to guide the diagnosis of KD.
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Affiliation(s)
- Wendy Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Mohammad Shukri Khoo
- Department of Pediatric, Hospital Wanita dan Kanak Kanak Sabah, Kota Kinabalu 88996, Malaysia;
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
- Correspondence: ; Tel.: +603-91748510
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Ae R, Maddox RA, Abrams JY, Schonberger LB, Nakamura Y, Kuwabara M, Makino N, Kosami K, Matsubara Y, Matsubara D, Sasahara T, Belay ED. Kawasaki Disease With Coronary Artery Lesions Detected at Initial Echocardiography. J Am Heart Assoc 2021; 10:e019853. [PMID: 33787310 PMCID: PMC8174370 DOI: 10.1161/jaha.120.019853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Detection of coronary artery lesions (CALs) at initial echocardiography can aid in diagnosing Kawasaki disease (KD) and inform primary adjunctive treatments. We aimed to characterize patients with KD with CALs detected at initial echocardiography. Methods and Results We analyzed data from the nationwide Japanese KD survey that contained information on 103 222 population‐based patients diagnosed with KD across Japan during 2011 to 2018. Patients with CALs detected at initial echocardiography were assessed by age, day of illness, and number of principal KD signs (≥3). Multivariable logistic regression analysis was performed to evaluate factors independently associated with CAL detection. Overall, 3707 (3.6%) patients had CALs detected at initial echocardiography. Patients aged <12 and ≥60 months were associated with CAL detection (adjusted odds ratio [95% CI], 1.28 [1.18‒1.39] and 1.32 [1.20‒1.45], respectively; reference, 12‒59 months). Patients with delayed hospital visits were increasingly at higher risk for CAL detection (days 7‒8, 1.84 [1.63‒2.08]; days 9–10, 4.30 [3.58–5.15]; and days ≥11, 9.12 [7.63‒10.90]; reference, days 1–4). Patients with 3 or 4 principal KD signs were independently associated with CAL detection (1.75 [1.63‒1.88]). These patients were significantly more likely to be aged <12 months but were not associated with delayed hospital visit. Younger patients visited at earlier days of illness. Conclusions Timely diagnosis could be beneficial for patients with KD. However, even when the hospital visit occurred early in the course of illness, patients with 3 or 4 principal KD signs, especially younger patients, were at higher risk of CAL detection at initial echocardiography.
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Affiliation(s)
- Ryusuke Ae
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA.,Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Ryan A Maddox
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Joseph Y Abrams
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Lawrence B Schonberger
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Yosikazu Nakamura
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Masanari Kuwabara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Nobuko Makino
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Koki Kosami
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Yuri Matsubara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | | | - Teppei Sasahara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Ermias D Belay
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
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