Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis

J Pediatr. 2022 Apr:243:167-172.e1. doi: 10.1016/j.jpeds.2021.12.054. Epub 2021 Dec 27.

Abstract

Objective: To assess whether 'treatment day' is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG).

Study design: Patient data from (n = 1016) a single center were collected for an observational cohort study. After exclusions, we retrospectively analyzed 776 patients in total. A multivariate analysis was performed with treatment day as a continuous variable (n = 691). Patients were categorized as no enlargement, small CAA, medium CAA, and giant CAA.

Results: Late treatment per-day was a significant predicting factor for the development of larger CAAs. ORs for medium and giant CAAs per delayed day were 1.1 (95% CI 1.1-1.2) P < .05 and 1.2 (95% CI 1.1-1.2) P < .05, respectively.

Conclusion: We showed that every day of delay in treatment of patients with Kawasaki disease inherently carries a risk of medium and giant aneurysm formation. There was no cut-off point for treatment day that could mark a safe zone.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Aneurysm* / etiology
  • Coronary Artery Disease*
  • Coronary Vessels / diagnostic imaging
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Infant
  • Mucocutaneous Lymph Node Syndrome* / complications
  • Mucocutaneous Lymph Node Syndrome* / drug therapy
  • Retrospective Studies
  • Risk Assessment

Substances

  • Immunoglobulins, Intravenous