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Narayan HK, Lizcano A, Lam-Hine T, Ulloa-Gutierrez R, Bainto EV, Garrido-García LM, Estripeaut D, Del Aguila O, Gómez V, Faugier-Fuentes E, Miño-León G, Beltrán S, Cofré F, Chacon-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Dueñas L, Luciani K, Rodríguez-Quiroz FJ, Camacho Moreno G, Viviani T, Alvarez-Olmos MI, Marques HHDS, López-Medina E, Pirez MC, Tremoulet AH. Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network. J Pediatr 2023; 263:113346. [PMID: 36775190 DOI: 10.1016/j.jpeds.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). STUDY DESIGN An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). RESULTS Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). CONCLUSION From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.
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Affiliation(s)
- Hari K Narayan
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | - Anel Lizcano
- Department of Biology, San Francisco State University, San Francisco, CA
| | - Tracy Lam-Hine
- School of Public Health, University of California Berkeley, Berkeley, CA; Department of Epidemiology & Public Health, Stanford University, Stanford, CA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Emelia V Bainto
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | | | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad Panamá, Panamá
| | - Olguita Del Aguila
- Unidad de Infectología Pediátrica, Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Virgen Gómez
- Servicio de Infectología, Centro Médico Universidad Central del Este Hospital y Hospital Infantil "Dr. Robert Reid Cabral", Santo Domingo, Dominican Republic
| | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Greta Miño-León
- Servicio de Infectología, Hospital del Niño "Francisco de Icaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología Pediátrica, Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | - Enrique Chacon-Cruz
- Servicio de Infectología Pediátrica, Hospital General de Tijuana, Tijuana, México
| | | | | | - Lourdes Dueñas
- Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panamá
| | | | - Germán Camacho Moreno
- Servicio de Infectología, HOMI, Fundación Hospital Pediátrico La Misericordia & Universidad Nacional de Colombia, Bogotá, Colombia
| | - Tamara Viviani
- Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
| | - Martha I Alvarez-Olmos
- Servicio de Infectología Pediátrica, Fundación Cardioinfantil & Universidad El Bosque, Bogotá, Colombia
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Departamento de Pediatría, Universidad del Valle y Centro Médico Imbanaco, Cali, Colombia, 25 Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - María C Pirez
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Adriana H Tremoulet
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA.
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Zhu H, Yu SF, Bai YX, Liang YY, Su XW, Pan JY. Kawasaki disease in children: Epidemiology, clinical symptoms and diagnostics of 231 cases in 10 years. Exp Ther Med 2015; 10:357-361. [PMID: 26170962 DOI: 10.3892/etm.2015.2487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/13/2015] [Indexed: 12/15/2022] Open
Abstract
The present study was a retrospective analysis of the dynamic changes and clinical characteristics of 231 cases of Kawasaki disease (KD) in pediatric patients admitted to the People's Hospital of Inner Mongolia between January 2003 and December 2012. A total of 37.23% of the cases occurred in the first 5 years, compared with 62.77% in the latter 5 years. The age distribution ranged from 3 months to 10 years, with a peak age of <1 year. The male-to-female ratio was 2.12:1, and the reoccurrence rate was 1.3%. Among the patient cohort, 7.8% were Mongolian children. The most common clinical symptom was fever (87.6%), while perianal skin peeling was the most rare (14.1%). With regard to the analyzed biomarkers, 90.4% of patients had abnormal platelet (PLT) counts; the next highest abnormality rates were associated with erythrocyte sedimentation rate (ESR) (74.46%) and white blood cell (WBC) counts (59.74%), followed by levels of C-reactive protein (CRP) (57.58%), creatinine kinase-MB (40.26%) and hemoglobin (Hb) (38.53%). In conclusion, the present study has found that approximately two-thirds of cases of KD over a 10-year period occurred in the latter 5 years. Changes in a number of experimental indicators, including PLT, ESR and WBC, could be used in the diagnosis of the condition and to reflect the success of the clinical treatment.
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Affiliation(s)
- Hua Zhu
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Shao-Fei Yu
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Yu-Xin Bai
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Yan-Yan Liang
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Xue-Wen Su
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Jing-Ying Pan
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
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Duan Y, Wang X, Cheng Z, Wu D, Wu L. Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease. Br J Radiol 2012; 85:e1190-7. [PMID: 22932064 DOI: 10.1259/bjr/18174517] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aim of this study was to prospectively evaluate the initial application and value of prospective electrocardiogram (ECG)-triggered dual-source CT coronary angiography (DSCTCA) in the diagnosis of infants and children with coronary artery aneurysms due to Kawasaki disease. METHODS 19 children [12 males; mean age 13.47 months, range 3 months to 5 years; mean heart rate 112 beats per minute (bpm), range 83-141 bpm] underwent prospective ECG-triggered DSCTCA with free breathing. Subjective image quality was assessed on a five-point scale (1, excellent; 5, non-diagnostic) by two blinded observers. The location, number and size of each aneurysm were observed and compared with those of transthoracic echocardiography (TTE) performed within 1 week. Interobserver agreement concerning the subjective image quality was evaluated with Cohen's κ-test. Bland-Altman analysis was used to evaluate the agreement on measurements (diameter and length of aneurysms) between DSCTCA and TTE. The average effective dose required for DSCTCA was calculated for all children. RESULTS All interobserver agreement for subjective image quality assessment was excellent (κ=0.87). The mean ± standard deviation (SD) aneurysm diameter with DSCTCA was 0.76 ± 0.36 cm and with TTE was 0.76 ± 0.39 cm. The mean ± SD aneurysm length with DSCTCA was 2.06 ± 1.35 cm and with TTE was 2.00 ± 1.22 cm. The Bland-Altman plot for agreement between DSCTCA and TTE measurements showed good agreement. The mean effective dose was 0.36 ± 0.06 mSv. CONCLUSION As an alternative diagnostic modality, prospective ECG-triggered DSCTCA with excellent image quality and low radiation exposure has been proved useful for diagnosing infants and children with coronary artery aneurysms due to Kawasaki disease. ADVANCES IN KNOWLEDGE Prospective ECG-triggered DSCTCA for infants and children allows rapid, accurate assessment of coronary aneurysms due to Kawasaki diseases, compared with TTE.
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Affiliation(s)
- Y Duan
- Medical School of Shandong University, Shandong Medical Imaging Research Institute, Jinan, China
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