Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age

Eur J Pediatr. 2009 Nov;168(11):1315-21. doi: 10.1007/s00431-009-0925-0. Epub 2009 Jan 22.

Abstract

Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age.

Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings.

Results: While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1 +/- 3.3 vs 6.3 +/- 1.9 days, p = 0.002) and showed fewer diagnostic symptoms (3.0 +/- 1.2 vs 4.3 +/- 1.1, p < 0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1 +/- 10.4 vs 6.5 +/- 1.9 days, p = 0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9 +/- 9.6 vs 1.1 +/- 0.8 days, p = 0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR = 0.494, 95% confidence interval (CI) = 0.281-0.871, p = 0.015) in the younger group and the duration of post-IVGG fever (OR = 1.958, 95% CI = 1.098-3.492, p = 0.023) and the Harada score (OR = 3.455, 95% CI = 1.012-11.796, p = 0.048) in the older group.

Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.

Publication types

  • Comparative Study

MeSH terms

  • Age Distribution
  • Age Factors
  • Algorithms
  • Biomarkers / blood
  • Blood Sedimentation
  • C-Reactive Protein / metabolism
  • Child, Preschool
  • Coronary Aneurysm / blood
  • Coronary Aneurysm / complications*
  • Coronary Aneurysm / diagnosis
  • Coronary Aneurysm / drug therapy
  • Coronary Aneurysm / epidemiology
  • Coronary Disease / complications
  • Diagnosis, Differential
  • Electrocardiography
  • Female
  • Humans
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / therapeutic use
  • Incidence
  • Infant
  • Injections, Intravenous
  • Male
  • Mucocutaneous Lymph Node Syndrome / blood
  • Mucocutaneous Lymph Node Syndrome / complications*
  • Mucocutaneous Lymph Node Syndrome / diagnosis
  • Mucocutaneous Lymph Node Syndrome / drug therapy
  • Mucocutaneous Lymph Node Syndrome / epidemiology
  • Natriuretic Agents / blood
  • Natriuretic Peptide, Brain / blood
  • Predictive Value of Tests
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Treatment Failure
  • Treatment Outcome
  • gamma-Globulins / administration & dosage
  • gamma-Globulins / therapeutic use

Substances

  • Biomarkers
  • Immunologic Factors
  • Natriuretic Agents
  • gamma-Globulins
  • Natriuretic Peptide, Brain
  • C-Reactive Protein