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A new scoring system to predict Kawasaki disease with coronary artery lesions

  • Wang Hua
  • Feiyue Ma
  • Ying Wang
  • Songling Fu
  • Wei Wang
  • Chunhong Xie
  • Yiying Zhang
  • Fangqi Gong
Original Article
  • 4 Downloads

Abstract

Objectives

To clarify the independent risk factors and construct a scoring system for Kawasaki disease (KD) with coronary artery lesions (CAL) at acute and subacute stages.

Method

Data of KD inpatients at acute and subacute stages were reviewed in a tertiary care center from January 2009 to December 2014.

Results

A total of 2305 acute and subacute KD cases were enrolled in this study with a CAL rate of 24.1%. The OR (95%CI) values of male, total fever duration ≥ 8 days, IVIG resistance (IVIGR), albumin (ALB) ≤ 35.9 g/L, eosionphils (EO) ≥ 2.2%, and monocytes (MO) ≥ 5.9% were 1.45 (1.15–1.82), 1.78 (1.43–2.22), 1.42 (1.09–1.85), 1.53 (1.23–1.91), 1.17 (0.94–1.45), and 1.37 (1.09–1.69), respectively. In patients ≤ 6 months old, the OR (95%CI) values for total fever duration ≥8 days, delayed diagnosis, and ALB ≤ 35.9 g/L were 3.61 (2.02–6.45), 3.49 (1.49–8.16), and 2.07 (1.14–3.74), respectively. ROC curve showed that the AUC value and sensitivity and specificity of predicting KD with CAL in patients ≤ 6 months old were 0.731, 64.7%, and 80.9%, respectively.

Conclusions

The independent risk factors for acute and subacute KD combined with CAL, including being a boy, long fever duration, IVIGR, low ALB, elevated EO, and MO. Joint of parameters (total fever duration ≥ 8 days, delayed diagnosis, and ALB ≤ 35.9 g/L) can be used to predict the occurrence of CAL in KD patients ≤ 6 months old.

Keywords

Coronary artery lesions Kawasaki disease Scoring systems 

Notes

Funding source

This work is supported, in part, by grants from the National Natural Science Foundation of China (No. 81670251), Natural Science Foundation of Zhejiang Province (No. LY16H020001), and Research Foundation of Health Bureau of Zhejiang Province (No. 2016KYB175).

Compliance with ethical standards

Ethical approval

The retrospective studies have been approved by the ethics committee in our hospital and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Disclosure

None.

References

  1. 1.
    Chen J, Liu Y, Liu W, Wu Z (2011) A meta-analysis of the biomarkers associated with coronary artery lesions secondary to Kawasaki disease in Chinese children. J Huazhong Univ Sci Technolog Med Sci 31(5):705–711.  https://doi.org/10.1007/s11596-011-0587-9 CrossRefPubMedGoogle Scholar
  2. 2.
    Honkanen VE, McCrindle BW, Laxer RM, Feldman BM, Schneider R, Silverman ED (2003) Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cardiol 24(2):122–126.  https://doi.org/10.1007/s00246-002-0063-1 CrossRefPubMedGoogle Scholar
  3. 3.
    Tremoulet AH, Best BM, Song S, Wang S, Corinaldesi E, Eichenfield JR, Martin DD, Newburger JW, Burns JC (2008) Resistance to intravenous immunoglobulin in children with Kawasaki disease. J Pediatr 153(1):117–121.  https://doi.org/10.1016/j.jpeds.2007.12.021 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sato S, Kawashima H, Kashiwagi Y, Hoshika A (2013) Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients. Int J Rheum Dis 16(2):168–172.  https://doi.org/10.1111/1756-185X.12082 CrossRefPubMedGoogle Scholar
  5. 5.
    Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, Ishii M, Harada K (2005) Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 47(2):232–234.  https://doi.org/10.1111/j.1442-200x.2005.02033.x CrossRefPubMedGoogle Scholar
  6. 6.
    Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, Yashiro M, Nakamura Y, Yanagawa H (2007) Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 49(4):421–426.  https://doi.org/10.1111/j.1442-200X.2007.02396.x CrossRefPubMedGoogle Scholar
  7. 7.
    Muta H, Ishii M, Furui J, Nakamura Y, Matsuishi T (2006) Risk factors associated with the need for additional intravenous gamma-globulin therapy for Kawasaki disease. Acta Paediatr 95(2):189–193.  https://doi.org/10.1080/08035250500327328 CrossRefPubMedGoogle Scholar
  8. 8.
    Tremoulet AH, Jain S, Chandrasekar D, Sun X, Sato Y, Burns JC (2011) Evolution of laboratory values in patients with Kawasaki disease. Pediatr Infect Dis J 30(12):1022–1026.  https://doi.org/10.1097/INF.0b013e31822d4f56 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, Printz BF, Klein GL, Sundel RP, Takahashi M, Li JS, Vetter VL, Newburger JW (2007) Delayed diagnosis of Kawasaki disease: what are the risk factors. Pediatrics 120(6):e1434–e1440.  https://doi.org/10.1542/peds.2007-0815 CrossRefPubMedGoogle Scholar
  10. 10.
    Fu PP, Du ZD, Pan YS (2013) Novel predictors of intravenous immunoglobulin resistance in Chinese children with Kawasaki disease. Pediatr Infect Dis J 32(8):e319–e323.  https://doi.org/10.1097/INF.0b013e31828e887f CrossRefPubMedGoogle Scholar
  11. 11.
    Wang Y, Wang W, Gong F, Fu S, Zhang Q, Hu J, Qi Y, Xie C, Zhang Y (2013) Evaluation of intravenous immunoglobulin resistance and coronary artery lesions in relation to Th1/Th2 cytokine profiles in patients with Kawasaki disease. Arthritis Rheum 65(3):805–814.  https://doi.org/10.1002/art.37815 CrossRefPubMedGoogle Scholar
  12. 12.
    Nakamura Y, Yashiro M, Uehara R, Sadakane A, Chihara I, Aoyama Y, Kotani K, Yanagawa H (2010) Epidemiologic features of Kawasaki disease in Japan: results of the 2007-2008 nationwide survey. J Epidemiol 20(4):302–307CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Nakamura Y, Yashiro M, Uehara R, Sadakane A, Tsuboi S, Aoyama Y, Kotani K, Tsogzolbaatar EO, Yanagawa H (2012) Epidemiologic features of Kawasaki disease in Japan: results of the 2009-2010 nationwide survey. J Epidemiol 22(3):216–221CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Belay ED, Maddox RA, Holman RC, Curns AT, Ballah K, Schonberger LB (2006) Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. Pediatr Infect Dis J 25(3):245–249.  https://doi.org/10.1097/01.inf.0000202068.30956.16 CrossRefPubMedGoogle Scholar
  15. 15.
    Kim GB, Han JW, Park YW, Song MS, Hong YM, Cha SH, Kim DS, Park S (2014) Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. Pediatr Infect Dis J 33(1):24–27.  https://doi.org/10.1097/INF.0000000000000010 CrossRefPubMedGoogle Scholar
  16. 16.
    Du ZD, Zhao D, Du J, Zhang YL, Lin Y, Liu C, Zhang T (2007) Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004. Pediatr Infect Dis J 26(5):449–451.  https://doi.org/10.1097/01.inf.0000261196.79223.18 CrossRefPubMedGoogle Scholar
  17. 17.
    Ma XJ, Yu CY, Huang M, Chen SB, Huang MR, Huang GY (2010) Epidemiologic features of Kawasaki disease in Shanghai from 2003 through 2007. Chin Med J 123(19):2629–2634PubMedGoogle Scholar
  18. 18.
    Wilder MS, Palinkas LA, Kao AS, Bastian JF, Turner CL, Burns JC (2007) Delayed diagnosis by physicians contributes to the development of coronary artery aneurysms in children with Kawasaki syndrome. Pediatr Infect Dis J 26(3):256–260CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kim JJ, Hong YM, Yun SW, Han MK, Lee KY, Song MS, Lee HD, Kim DS, Sohn S, Ha KS, Hong SJ, Kim KJ, Park IS, Jang GY, Lee JK (2012) Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol 33(4):513–520.  https://doi.org/10.1007/s00246-011-0143-1 CrossRefGoogle Scholar
  20. 20.
    Miura M, Ohki H, Tsuchihashi T, Yamagishi H, Katada Y, Yamada K, Yamashita Y, Sugaya A, Komiyama O, Shiro H (2004) Coronary risk factors in Kawasaki disease treated with additional gammaglobulin. Arch Dis Child 89(8):776–780.  https://doi.org/10.1136/adc.2003.032748 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mori M, Imagawa T, Yasui K, Kanaya A, Yokota S (2000) Predictors of coronary artery lesions after intravenous gamma-globulin treatment in Kawasaki disease. J Pediatr 137(2):177–180.  https://doi.org/10.1067/mpd.2000.107890 CrossRefPubMedGoogle Scholar
  22. 22.
    Asadi-Pooya AA, Borzoee M, Amoozgar H (2006) The experience with 113 patients with Kawasaki disease in Fars Province, Iran. Turk J Pediatr 48(2):109–114PubMedGoogle Scholar
  23. 23.
    Ruan Y, Ye B, Zhao X (2013) Clinical characteristics of Kawasaki syndrome and the risk factors for coronary artery lesions in China. Pediatr Infect Dis J 32(10):e397–e402.  https://doi.org/10.1097/INF.0b013e31829dd45e CrossRefPubMedGoogle Scholar
  24. 24.
    Yeo Y, Kim T, Ha K, Jang G, Lee J, Lee K, Son C, Lee J (2009) Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 168(2):157–162.  https://doi.org/10.1007/s00431-008-0722-1 CrossRefPubMedGoogle Scholar
  25. 25.
    Muta H, Ishii M, Egami K, Hayasaka S, Nakamura Y, Yanagawa H, Matsuishi T (2005) Serum sodium levels in patients with Kawasaki disease. Pediatr Cardiol 26(4):404–407.  https://doi.org/10.1007/s00246-004-0789-z CrossRefPubMedGoogle Scholar
  26. 26.
    Suzuki H, Takeuchi T, Minami T, Shibuta S, Uemura S, Yoshikawa N (2003) Water retention in the acute phase of Kawasaki disease: relationship between oedema and the development of coronary arterial lesions. Eur J Pediatr 162(12):856–859.  https://doi.org/10.1007/s00431-003-1326-4 CrossRefPubMedGoogle Scholar
  27. 27.
    Kawamura Y, Takeshita S, Kanai T, Yoshida Y, Nonoyama S (2016) The combined usefulness of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting intravenous immunoglobulin resistance with Kawasaki disease. J Pediatr 178:281–284.e1.  https://doi.org/10.1016/j.jpeds.2016.07.035 CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Wang Hua
    • 1
  • Feiyue Ma
    • 1
  • Ying Wang
    • 1
  • Songling Fu
    • 1
  • Wei Wang
    • 1
  • Chunhong Xie
    • 1
  • Yiying Zhang
    • 1
  • Fangqi Gong
    • 1
  1. 1.Department of Cardiology, Children’s HospitalZhejiang University School of MedicineHangzhouPeople’s Republic of China

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