Marianna Fabi1, Laura Andreozzi2, Ilaria Frabboni2, Ada Dormi3, Elena Corinaldesi4, Francesca Lami5, Cristina Cicero6, Bertrand Tchana7, Rosa Francavilla8, Monica Sprocati9, Barbara Bigucci10, Claudia Balsamo11, Paola Sogno Valin12, Giorgia Di Fazzio13, Lorenzo Iughetti5, Enrico Valletta14, Federico Marchetti15, Andrea Donti16, Marcello Lanari2. 1. Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy. marianna.fabi@aosp.bo.it. 2. Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy. 3. Department of Medical and Surgical Science, DIMEC, University of Bologna, Bologna, Italy. 4. Department of Pediatrics, Ramazzini Hospital, Carpi, Italy. 5. Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy. 6. Department of Pediatrics, AUSL, Guglielmo da Saliceto Hospital, Piacenza, Italy. 7. Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma, Italy. 8. Department of Pediatrics, Maggiore Hospital, Bologna, Italy. 9. Department of Pediatrics, Arcispedale Sant'Anna, Ferrara, Italy. 10. Department of Pediatrics, Infermi Hospital, Rimini, Italy. 11. Department of Pediatrics, Bufalini Hospital, Cesena, Italy. 12. Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy. 13. Department of Pediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 14. Department of Pediatrics, G.B.Morgagni - L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy. 15. Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy. 16. Pediatric Cardiology and Adult Congenital Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVES: Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children in high-income countries because of coronary artery involvement. Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. METHODS: Multicenter retrospective and prospective study including 372 consecutive children (58% boys; mean age 34.3 ± 30.3 months, Caucasian 85%) was diagnosed with KD. We divided the cohort into 2 groups according to the presence of coronary anomalies (CAA) and aneurysms. We compared the groups and studied the risk factors for CAA and for aneurysms, the most severe lesions. RESULTS: Children with CAA were 91/372 (24.46%, aneurysms 20/372, 5.37%). Children with CAA were more likely to have a longer duration of fever (p < 0.001), later day of treatment (p < 0.001), to be IVIG non-responders and late treated (p < 0.001), while age, clinical presentation, and seasonality were not different. They also had significantly higher WBC and neutrophils, lower lymphocytes, Hb and Na during the acute stage, and slower resolution of inflammation. Age, IVIG unresponsiveness, and presence of non-coronary cardiac findings were independent risk factors for CAA and for aneurysms, while neutrophils just for CAA. Age under 6 months was a risk factor for the aneurysm. Aneurysms occurred more frequently in the first quartile of the age of KD onset (under 14 months). CONCLUSION: Very young children with non-coronary cardiac findings are at increased risk for a more severe form of KD with aneurysms. These children could benefit from adjunctive therapy beside IVIG, especially if they have higher markers of inflammation, particularly neutrophils. Key points • Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. • Risk factors for coronary involvement have been extensively studied in the Asian population, and others have been validated in cohorts with mixed ethnicities. • In our predominantly Caucasian population, non-coronary cardiac findings, age younger than 6 months, and IVIG unresponsiveness are independent risk factors for a more severe form of KD with aneurysms.
OBJECTIVES:Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children in high-income countries because of coronary artery involvement. Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. METHODS: Multicenter retrospective and prospective study including 372 consecutive children (58% boys; mean age 34.3 ± 30.3 months, Caucasian 85%) was diagnosed with KD. We divided the cohort into 2 groups according to the presence of coronary anomalies (CAA) and aneurysms. We compared the groups and studied the risk factors for CAA and for aneurysms, the most severe lesions. RESULTS:Children with CAA were 91/372 (24.46%, aneurysms 20/372, 5.37%). Children with CAA were more likely to have a longer duration of fever (p < 0.001), later day of treatment (p < 0.001), to be IVIG non-responders and late treated (p < 0.001), while age, clinical presentation, and seasonality were not different. They also had significantly higher WBC and neutrophils, lower lymphocytes, Hb and Na during the acute stage, and slower resolution of inflammation. Age, IVIG unresponsiveness, and presence of non-coronary cardiac findings were independent risk factors for CAA and for aneurysms, while neutrophils just for CAA. Age under 6 months was a risk factor for the aneurysm. Aneurysms occurred more frequently in the first quartile of the age of KD onset (under 14 months). CONCLUSION: Very young children with non-coronary cardiac findings are at increased risk for a more severe form of KD with aneurysms. These children could benefit from adjunctive therapy beside IVIG, especially if they have higher markers of inflammation, particularly neutrophils. Key points • Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. • Risk factors for coronary involvement have been extensively studied in the Asian population, and others have been validated in cohorts with mixed ethnicities. • In our predominantly Caucasian population, non-coronary cardiac findings, age younger than 6 months, and IVIG unresponsiveness are independent risk factors for a more severe form of KD with aneurysms.
Authors: Lori B Daniels; Matthew S Tjajadi; Hannah H Walford; Susan Jimenez-Fernandez; Vera Trofimenko; Daryl B Fick; Hoang-Anh L Phan; Peter E Linz; Keshav Nayak; Andrew M Kahn; Jane C Burns; John B Gordon Journal: Circulation Date: 2012-05-17 Impact factor: 29.690
Authors: Brian W McCrindle; Anne H Rowley; Jane W Newburger; Jane C Burns; Anne F Bolger; Michael Gewitz; Annette L Baker; Mary Anne Jackson; Masato Takahashi; Pinak B Shah; Tohru Kobayashi; Mei-Hwan Wu; Tsutomu T Saji; Elfriede Pahl Journal: Circulation Date: 2017-03-29 Impact factor: 29.690