ABSTRACT
Purpose: Multisystem inflammatory syndrome in children, which has overlapping clinical features with Kawasaki disease (KD), has generated considerable interest in the relationship between KD and infectious diseases during the ongoing global outbreak of coronavirus disease 2019. However, few studies have focused on the relationship between KD and concomitant infection, and reports on the relationship between infections and recovery from coronary artery aneurysms (CAA) are even rarer. Methods: : Patients were classified into case and control groups according to the results of their pathogen examinations, and the baseline characteristics of the two groups were compared. The Kaplan–Meier survival analysis was used to compare the medium-term recovery time of CAA between patients with and without infections, and multivariable analyses were performed to evaluate potential risk factors associated with CAA without recovery between 1 and 2 years of follow-up. Results: : A total of 353 pediatric patients with KD were included, of whom 83 (23.5%) had confirmed co-infection. There were no significant differences in patients’ response to treatment and coronary artery outcome when compared between patients with and without infections. Among the 90 patients diagnosed with CAA, 20 (22.2%) had confirmed co-infection, and no significant differences were observed in coronary artery changes from baseline at 2 weeks, 4 weeks, and 3 months in patients with CAA with and without infections. The estimated median time (6 months, 95%CI:1.920–10.080) was higher in the CAA co-infected group than in the CAA non-infected group (3 months, 95%CI:2.366–3.634), with no significant difference. Multivariate analysis revealed that a high Z-score of the coronary artery internal diameter at 1 month after onset was significantly associated with CAA without recovery. The Z score of the left main coronary artery was ≥3.215 with an 89% sensitivity and 77% specificity in predicting CAA without recovery within 1 year of onset. The Z score of the right coronary artery was ≥3.845 with a 64% sensitivity and 98% specificity in predicting CAA without recovery within 1 year of onset and with an 83% sensitivity and 88% specificity within 2 years of onset. Conclusions: : Concomitant infection with KD diagnosis did not affect the patients’ response to IVIG treatment and coronary artery outcome when compared with patients without infections; however, the time to coronary artery normalization was not notably prolonged in CAA patients with infections, but a larger maximum Z score at 1 month after onset was a risk factor significantly associated with coronary artery dilatation without recovery within 2 years of onset.