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Predictive risk factors for coronary artery abnormalities in Kawasaki disease

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Abstract

Clinical characteristics to predict the development of coronary artery abnormalities (CAA) in Kawasaki disease (KD) were assessed by reviewing medical records of patients diagnosed with KD at Korea University Medical Center from March 2001 to February 2005. Of the 285 patients diagnosed with KD, 19 developed CAA (6.7%). Compared with the CAA(−) group, the CAA(+) group had a longer duration of fever after intravenous gamma-globulin (IVGG) injection (2.4±2.9 vs. 1.5±1.2 days, p=0.008) and higher C-reactive protein (CRP)(12.3±7.8 vs. 8.7±7.1 mg/dL, p=0.038). In particular, the CAA(+) group tended to have more than 7 days of fever before IVGG and more than 3 days of fever after IVGG (26.3 vs. 5.3%, p<0.001; 26.3 vs. 6.4%, p=0.002). When the IVGG responsiveness was defined by the presence of defervescence within 3 days after IVGG, IVGG-non-responders showed a higher incidence of CAA (22.7 vs. 5.3%, p=0.002). Non-responders had a longer duration of fever after IVGG (5.5±1.9 vs. 1.2±0.6 days, p<0.001) and a significantly increased CRP, AST, ALT and total bilirubin. Multivariate regression analysis for CAA showed that the only factor significantly associated with the development of CAA was total fever that lasted for longer than 8 days (OR=4.052, 95% CI=1.151–14.263, p=0.0293). Conclusively, the most important predictor of CAA in KD is total duration of fever longer than 8 days. Early identification of IVGG non-responders and active therapeutic intervention for fever in KD cases might decrease the incidence of CAA.

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Abbreviations

KD:

Kawasaki disease

IVGG:

intravenous gamma-globulin

CAA:

coronary artery abnormalities

CRP:

C-reactive protein

BNP:

B-type natriuretic peptide

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Authors and Affiliations

  1. Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea

    TaeYeun Kim, WookSun Choi, Chan-Wook Woo, ByungMin Choi, JungHwa Lee, KwangChul Lee, ChangSung Son & JooWon Lee

  2. Department of Pediatrics, Korea University Medical Center, Kojan-dong 516, Ansan-si, Kyungki-do, Republic of Korea

    JungHwa Lee

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  1. TaeYeun Kim
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  2. WookSun Choi
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Correspondence to JungHwa Lee.

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Kim, T., Choi, W., Woo, CW. et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 166, 421–425 (2007). https://doi.org/10.1007/s00431-006-0251-8

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  • DOI: https://doi.org/10.1007/s00431-006-0251-8

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