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Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease

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Abstract

Introduction/objectives

Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) identified after acute Kawasaki disease (KD). However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. We hypothesized the association of serum sodium level with CAL complications differs between infants and older patients with KD.

Methods

We analyzed 21,610 population-based patients who developed KD throughout Japan during 2013–2014. We performed multivariable logistic regression analyses to evaluate the association between serum sodium and CAL complications. Additionally, we stratified the serum sodium distribution associated with CAL complications by infants and older patients.

Results

CALs were identified in 158 (3.6%) infants and 302 (1.8%) older patients. Infants were more likely to develop CALs when within the normal sodium range compared with older patients (75% vs. 29%), whereas most older patients developed CALs with a sodium level lower than the reference interval. Serum sodium ≤ 130 mEq/L indicated significantly higher risk for development of CALs in both groups (adjusted odds ratio [95% confidence intervals] = 3.21 [1.65–6.25] in infants and 1.74 [1.18–2.57] in older patients).

Conclusions

Serum sodium distribution associated with CAL complications differed greatly between infants and older patients. Older patients developed CALs with sodium levels lower than the reference interval; however, among infants, hyponatremia was not necessarily a risk factor for developing coronary artery lesion. When considering risk assessments for CALs using serum sodium levels, infants with KD should be distinguished from older patients.

Key Points

• Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) among patients with Kawasaki disease.

• However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children.

• Most infants developed CALs within the normal sodium range, whereas older patients developed at a range lower than the reference interval.

• These findings highlight that when considering risk assessments for CALs using serum sodium levels, infants should be distinguished from older patients.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the pediatricians who contributed to the nationwide survey of Kawasaki disease in Japan. The study was partially supported by grants and funding from a non-profit organization, The Japan Kawasaki Disease Research Center. We thank J. Ludovic Croxford, PhD, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

The study was partially supported by grants and funding from a non-profit organization, the Japan Kawasaki Disease Research Center.

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Authors and Affiliations

  1. Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan

    Hiroya Masuda, Ryusuke Ae, Koki Kosami, Kanako Hayashida, Nobuko Makino, Yuri Matsubara, Teppei Sasahara & Yosikazu Nakamura

  2. Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Hiroya Masuda, Masami Matsumura & Kanako Hayashida

  3. Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Taka-aki Koshimizu

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  1. Hiroya Masuda
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Contributions

HM: conceptualization, formal analysis, literature review, investigation, software, writing—original draft. RA: conceptualization, data curation, formal analysis, literature review, investigation, software, writing—original draft and review and editing. TK: formal analysis, investigation, methodology, software. MM: supervision, final approval. KK: formal analysis, investigation, methodology, software. KH: formal analysis, investigation, methodology, software. NM: data curation, supervision. YM: data curation, formal analysis. TS: data curation, Supervision. YN: funding acquisition, conceptualization, investigation, methodology, project administration, supervision, writing—review and editing, final approval.

Corresponding author

Correspondence to Ryusuke Ae.

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Ethics approval

The Jichi Medical University Clinical Research Ethics Committee approved the study and waived the requirement for informed consent from each participant (Approval ID: 18–070).

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All of the authors contributed significantly to the work, approved the manuscript, and agree with its submission and publication.

Conflict of interest

Dr. Nakamura has received grants and funding from a non-profit organization, the Japan Kawasaki Disease Research Center. The other authors have no conflicts of interest to declare.

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Ryusuke Ae contributed equally as the co-first author.

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Masuda, H., Ae, R., Koshimizu, Ta. et al. Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease. Clin Rheumatol 41, 137–145 (2022). https://doi.org/10.1007/s10067-021-05881-7

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