Risk Factors for Coronary Aneurysm in Kawasaki Disease in Central Thailand

Abstract

The most important complication of Kawasaki disease is coronary aneurysm (CA). The purpose of this study is to identify risk factors for coronary aneurysm in patients with Kawasaki disease treated at Sawanpracharak hospital during October 2006 to November 2011.

Clinical, laboratory and treatment of patients diagnosed with Kawasaki disease were reviewed and categorized into two groups, CA (+) and CA (-) group. Clinical variables of interest were compared between the two groups and independent risk factors for coronary aneurysm were analyzed using a cluster logistic regression model.

A total of 67 patients were diagnosed with Kawasaki disease, of these,11 patients developed coronary aneurysm (16.4%). The CA (+) group had higher white blood cell counts, higher platelet counts, longer time from onset of disease to start of IVIG (IVIGd), lower hematocrit levels, and lower serum albumin. Cluster logistic regression was applied by dividing patients into 3 age groups, less than 12, 12-60months, and over 60 months. Risk factors for coronary aneurysm were: total neutrophil count > 12,000 / mm (OR = 15.46, 95%CI 5.56-43.00, p<0.001), erythrocyte sedimentation rate (ESR) >80 mm/ hr (OR = 5.00, 95%CI 2.60-9.64, p < 0.001), IVIGd > 8 days (OR 17.04, 95%CI 6.45-45.03, p < 0.001). Area under the curve (ROC) was 0.8807.

Comparing patients with Kawasaki disease at the same age group, risk factors for coronary aneurysm were total neutrophil count > 12,000 / mm3, ESR > 80 mm/ hr and time from onset of disease to start of IVIG ≥ 8 days. When these risk factors are found in patients with Kawasaki disease, physicians should closely monitor these patients, give timely treatment, and consider early referral to a pediatric cardiologist.

coronary aneurysm - Kawasaki disease - risk factor

Correspondence to Pentip Supachokchaiwattana, MD, Department of Pediatrics. Sawanpracharak Hospital. Nakhonsawan. Thailand. Telephone: (+665) 621 9888. Fax: (+665) 621 9899. E-mail: pentip_s@yahoo.com.

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material

Nil

References

1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on cardiovascular disease in the young, American Heart Association. Circulation 2004;110:2747-71. PubMed   CrossRef

2. Thisyakorn C, Thisyakorn U. Kawasaki disease in Thai children. Pediatr Infect Dis J 1995; 14: 324-6. PubMed   CrossRef

3. Newburger JW, Fulton DR. Kawasaki disease. Curr Opin Pediatr 2004;16:508-14. PubMed   CrossRef

4. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Longterm consequences of kawasaki disease. A 10 to 21- year follow-up study of 594 patients. Circulation 1996;94:1379-85. PubMed   CrossRef

5. Durongpisitkul K, Gururaj VJ, Park JM, Martin CF. The prevention of coronary aneurysm in Kawasaki disease: a metaanalysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics. 1995;96:1057-61. PubMed

6. Manlhiot C, Yeung RSM, Clarizia NA, Chahal N, McCrindle BW. Kawasaki disease at the extremes of the age spectrum. Pediatrics 2009; 124;e410. PubMed   CrossRef ​

7. Muta H, Ishii M, Sakaue T, Ekami K, Furui J, Sugahara Y, et al. Older age is a risk factor for the development of cardiovascular sequelae in Kawasaki disease. Pediatrics 2004;114;751.

8. Song D, Yeo YK, Ha KS, Jang GY, Lee JH, Lee KC, et al. Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 2009; 168:1315-21. PubMed   CrossRef

9. Kim JJ, Hong YM, Yun SW, Han MK, Lee KY, Song MS, et al. Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol; published online:22 November 2011.

10. Hongkanen VEA, McCrindle BW, Laxer RM, Feldman BM, Schneider R, Silverman ED. Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cardiol 2003;24:122-6. CrossRef

11. Kim TY, Choi WS, Woo CW, Choi BM, Lee JH, Lee KC, et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 2007;166:421-5. PubMed   CrossRef

12. Nakamura Y, Yashiro M, Sadakane A, Aoyama Y, Oki I, Uehara R, et al. Six principal symptoms and coronary sequelae in Kawasaki disease. Pediatrics International 2009:51:705-8. PubMed   CrossRef

13. Research Committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo, Japan: Japanese Ministry of Health and welfare;1984

14. McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, et al. Coronary artery involvement in children with Kawaski disease Risk factors from analysis of serial normalized measurements. Circulation 2007;116:174-9. PubMed   CrossRef

15. Beiser AS, Takahashi M, Baker AL, Sundel RP, Newburger JW. A predictive instrument for coronary artery aneurysms in Kawasaki disease. Am J Cardiol 1998;81:116-20. CrossRef

16. Uehara R, Belay ED, Maddox RA, Holman RC, Nakamura Y, Yashiro M, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patient in Japan. Pediatr Infect Dis J 2008;27:155-60. PubMed

17. Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006; 113:2606-12. PubMed   CrossRef ​

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