Scoring method for identifying patients with Kawasaki disease at high risk of coronary artery aneurysms.

The beneficial effect of immunoglobulin in preventing coronary artery aneurysms in patients with Kawasaki disease is recognized, but immunoglobulin should be selectively given to patients at high risk for coronary lesions. The present study was designed to present a scoring method to evaluate the severity of Kawasaki disease in terms of coronary artery disease based on clinical and early laboratory findings. Seventy-eight patients who were admitted at 4 to 7 days of illness and who had received aspirin alone during the acute febrile period were separated into 2 groups according to significant coronary artery involvement, and possible related factors to the discrimination of the 2 groups were studied using multivariate analysis. Age at onset, C-reactive protein and platelet count contributed significantly to the discrimination, and from these 3 items a simple scoring system was devised to predict patients at high risk for coronary lesions. Retrospective study using this scoring method indicated that significant coronary artery disease was more often seen in patients predicted to be at high risk treated with aspirin, while no patients who received immunoglobulin had coronary lesions of moderate or severe degree. Thus, the present scoring method provides simple but clinically useful criteria for predicting patients at high risk of coronary artery disease, and immunoglobulin therapy for selected patients may reduce the significant coronary artery complications of Kawasaki disease.