A prediction model for coronary artery abnormalities in children with Kawasaki disease older than 5 years

Abstract Objective: Reliably prediction models for coronary artery abnormalities (CAA) in children aged > 5 years with Kawasaki disease (KD) are still lacking. This study aimed to develop a nomogram model for predicting CAA at 4 to 8 weeks of illness in children with KD older than 5 years. Methods: A total of 644 eligible children were randomly assigned to a training cohort (n = 450) and a validation cohort (n = 194). The least absolute shrinkage and selection operator (LASSO) analysis was used for optimal predictors selection, and multivariate logistic regression was used to develop a nomogram model based on the selected predictors. Area under the receiver operating characteristic curve (AUC), calibration curves, Hosmer-Lemeshow test, Brier score, and decision curve analysis (DCA) were used to assess model performance. Results: Neutrophil to lymphocyte ratio, intravenous immunoglobulin resistance, and maximum baseline z-score ≥ 2.5 were identified by LASSO as significant predictors. The model incorporating these variables showed good discrimination and calibration capacities in both training and validation cohorts. The AUC of the training cohort and validation cohort were 0.854 and 0.850, respectively. The DCA confirmed the clinical usefulness of the nomogram model. Conclusions: A novel nomogram model was established to accurately assess the risk of CAA at 4-8 weeks of onset among KD children older than 5 years, which may aid clinical decisionmaking.

Enfermedad de Kawasaki en lactantes bajo un año de edad: un reto para el diagnóstico y tratamiento de los pacientes. Experiencia en un centro hospitalario en México / Kawasaki disease in infants under one year of age: a challenge for the diagnosis and treatment of patients. Experience in a hospital center in Mexico

Resumen Antecedentes: La enfermedad de Kawasaki (EK) en lactantes bajo un año de edad es poco frecuente en la mayoría de los países. Este grupo de pacientes tienen mayor riesgo de desarrollar complicaciones cardiacas. Objetivo: Evaluar el comportamiento clínico, tratamiento empleado y pronóstico cardiaco en lactantes bajo un año de edad atendidos por EK en un hospital pediátrico de tercer nivel en la Ciudad de México. Pacientes y Métodos: Estudio retrospectivo, descriptivo, de pacientes con diagnóstico de EK desde agosto de 1995 a agosto de 2019. Se estudió la presentación clínica, los exámenes de laboratorio, el tratamiento administrado y el desarrollo de lesiones coronarias en pacientes bajo un año de edad y se comparó con pacientes mayores. Resultados: Se estudiaron 687 pacientes, 152 de ellos eran lactantes bajo un año de edad (22,1%). Hubo un mayor tiempo al diagnóstico de la EK en los lactantes menores, con un incremento de presentaciones clínicas incompletas; este grupo de pacientes desarrolló en forma más frecuente lesiones coronarias en comparación con los pacientes mayores y también tuvo un mayor porcentaje de aneurismas coronarios gigantes. Hubo dos fallecimientos en los lactantes menores, secundarios a infarto al miocardio. Conclusiones: El diagnóstico de EK en pacientes bajo un año de edad es un reto diagnóstico con presentaciones clínicas incompletas y mayor riesgo de desarrollar complicaciones cardiacas graves.

Abstract Background: Frequency of Kawasaki disease (KD) in infants is low in almost all countries. These patients are at higher risk of developing cardiac complications. Aim: To evaluate the clinical features, treatment used and cardiac outcome in infants under one year of age attending for KD in a third level pediatric hospital in Mexico City, Mexico. Methods: A cross-sectional study was conducted in our hospital from August 1995 to August 2019. We analyzed the clinical features, laboratory results, treatment used and cardiac outcomes in infants younger than one year of age and compared them with older patients. Results: We included 687 patients, 152 were younger than one year of age (22.1%). There was a delayed diagnosis in younger patients with an increased frequency of incomplete clinical presentations. Coronary artery abnormalities were most common in younger infants who also had an increased frequency of giant coronary artery aneurysms. Two patients in the younger group died in the acute phase of KD of myocardial infarction. Conclusions: Diagnosis of KD in infants younger than 1 year of age is a clinical challenge with an increased rate of incomplete clinical presentations and also an increased risk of development of severe cardiac complications.

Iron deficiency anemia as a predictor of coronary artery abnormalities in Kawasaki disease / 소아과

PURPOSE: Coronary artery abnormalities (CAA) are the most important complications of Kawasaki disease (KD). Iron deficiency anemia (IDA) is a prevalent micronutrient deficiency and its association with KD remains unknown. We hypothesized that presence of IDA could be a predictor of CAA. METHODS: This retrospective study included 173 KD patients, divided into 2 groups according to absence (group 1) and presence (group 2) of CAA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a logistic regression model to estimate the association between CAA and other indicators. Due to collinearity between indicators of IDA, each indicator was paired with anemia in 3 models. RESULTS: Serum iron, iron saturation, and ferritin concentration, the 3 indicators of IDA, were significantly higher in group 1 than in group 2. Three sets of models including anemia with iron indicators produced the OR of CAA of 3.513, 3.171, and 2.256, respectively. The 3 indicators of IDA were negatively associated with CAA, by OR of 0.965, 0.914, and 0.944, respectively. The areas under the curve (AUCs) of ferritin concentration, iron saturation, serum iron, anemia, and Kobayashi score were 0.907 (95% CI, 0.851–0.963), 0.729 (95% CI, 0.648–0.810), 0.711 (95% CI, 0.629–0.793), 0.638 (95% CI, 0.545–0.731), and 0.563 (95% CI, 0.489–0.636), respectively. CONCLUSION: Indicators of IDA, especially ferritin, were highly associated with CAA; therefore, they were stronger predictors of CAA than Kobayashi scores. IDA indicators can be used to predict CAA development and to suggest requirements for early interventions.

Coronary Artery Dilatation in Incomplete Kawasaki Disease.

We conducted this study to compare the incidence of coronary artery dilatation in children with Incomplete and Classical Kawasaki disease, diagnosed as per AHA criteria. Subjects were included on a retrospective review of records (2002-2007); those with a discharge diagnosis of Kawasaki disease were enrolled. A total of 29 patients were identified (3.1 per 1000 pediatric admissions), out of which 22 were boys (median age: 4.8 years; range: 4 months-11 years). Seventeen (58.6%) had Classical KD and twelve (41.4%) children had Incomplete KD. All children received IVIG and underwent echocardiography. Coronary involvement was more in Incomplete KD (11/12 = 91.6 %) as compared to Classical KD (7/17= 41.1%). The sensitivity, specificity and predictive value of AHA criteria to detect coronary artery dilatation was 39%, 9%, and 41%, respectively. We conclude that children presenting with Incomplete Kawasaki disease are at a higher risk of coronary artery abnormalities.

Kawasaki disease – An indian perspective.

Kawasaki disease (KD) was first reported from Japan in 1967 by a young pediatrician, Tomisaku Kawasaki, while working at the Red Cross Hospital in Tokyo. Soon therafter, Marian Melish independently reported children with a similar clinical profile from Hawaii in the United States. KD has now been reported from all parts of the world, including several centers in India. Based on the epidemiology and clinical features, an infectious etiology has been suspected for long but no definitive causative agent has been implicated so far. Like many other vasculitides, the diagnosis of this condition is based on the recognition of a temporal sequence of clinical features, none of which is pathognomonic in isolation. KD is believed to be the commonest vasculitic disorder of children. Incidence rates as high as 60-150 per 100,000 children below 5 years of age have been reported from several countries. In India (as also perhaps in many other developing countries), however, majority of children with KD continue to remain undiagnosed probably because of the lack of awareness amongst pediatricians. The clinical features of KD can be confused with other common conditions like scarlet fever and the Stevens Johnson syndrome, if the clinician is not careful. Development of coronary artery abnormalities (CAA) is the hallmark of KD and accounts for most of the morbidity and mortality associated with the disease. Prompt recognition of the disease and early initiation of treatment with intravenous immunoglobulin (IVIG) results in significant reduction in the occurrence of CAA. It is, therefore, imperative for the pediatrician to diagnose and treat KD expeditiously. KD should be considered in the differential diagnosis of all febrile illnesses in young children where the fever persists for more than 5-7 days.