Criterion for early prediction of coronary artery involvement by clinical manifestations in patients with Kawasaki disease.

One hundred and thirty patients with Kawasaki disease were examined by the clinical symptoms and findings in order to predict the coronary artery involvement in the early stage. These patients were tested by the two-dimensional echocardiography iteratively from the acute stage and categorized into the following three groups: Normal coronary artery, transient dilatation of the coronary artery and aneurysm of the coronary artery persisting eight weeks or more after the onset of the illness. Eighteen clinical symptoms and findings within the 14th, 21st and 35th day of the illness were studied. As a result of analysis, a criterion for the early prediction of the coronary artery involvement by clinical manifestations was established as follows: The patients who satisfy the following or are highly suspectable of having a coronary artery involvement: Fever persisting for 14 days or more. Fever persisting for 10 to 13 days, and when two or more out of the following four conditions are satisfied: The age at the onset of the illness is under one year. The lowest value of hemoglobin is 10.0 g/dl or less. The highest white blood cell count is 14000/cmm or more. The lowest value of serum albumin is 3.5 g/dl or less. Two false negative cases (6.5%) were recognized in 31 of the high risk group. Twenty-two false positive cases (22.2%) were observed in 99 of the normal group. One hundred and six cases out of the 130 cases (81.5%) satisfied this criterion. Therefore, this criterion was concluded to be useful to predict the coronary artery involvement in the earlier stage of the illness.