Association between maternal age and outcomes in Kawasaki disease patients

Abstract

Background The etiology of Kawasaki disease (KD) is still unknown; perinatal factors may have role with few studies. This study was aim to survey the perinatal factors and clinical outcome of KD, including coronary artery lesion (CAL) formation and intravenous immunoglobulin (IVIG) treatment response. Methods We enrolled a total of 185 KD patient–caregiver dyads in this study using questionnaires. The questionnaire included two categories: children’s characteristics, which consisted of age at disease onset, gender, gestational age at delivery, birth body weight, delivery methods, and breastfeeding status, and caregivers’ characteristics, which consisted of parents or not, education levels, maternal age at giving birth, total number of offspring, and family income. We analyzed the association of these factors with CAL formation and IVIG treatment response of KD. Results KD patients with CAL formation had a higher maternal age than non-CAL patients (32.49 ± 3.42 vs. 31.01 ± 3.92 years, p = 0.016). We also found that maternal age ≥ 32 years group had a higher rate of having KD patients with CAL (39/81 vs. 24/74, odds ratio 1.935, 95% confidence interval [1.007, 3.718], p = 0.047). The maternal age ≥ 35 years group had a higher rate of having KD patients with IVIG resistance (6/31 vs. 6/116, odds ratio 4.400, 95% confidence interval [1.309, 14.786], p = 0.01). There was no significant difference in either CAL formation or IVIG resistance in KD with regard to patient’s age at disease onset, gestational age, birth body weight, delivery methods, breastfeeding, caregiver type, caregivers’ education level, total number of offspring, or family income ( p > 0.05). Conclusions This study is the first to report that maternal age is significantly associated with CAL formation and IVIG resistance in KD. We hypothesize that a maternal age less than 32 years would benefit KD offspring.

CD177, a specific marker of neutrophil activation, is associated with coronavirus disease 2019 severity and death

“…Clinically, neutrophil chemotaxis, infiltration of endothelial cells, and extravasation into alveolar spaces have been described in lung autopsies from deceased patients with COVID-19 (Fu et al, 2020). Elevated CD177 mRNA expression has also been described for patients with acute Kawasaki disease (Huang et al, 2019) and resistant to IV Ig therapy (Jing et al, 2020;Ko et al, 2019), a syndrome that has been described as a possible complication of SARS-CoV-2 infection in children (Toubiana et al, 2020;Viner and Whittaker, 2020). Our results are also consistent with those obtained using animal models, suggesting an important role for neutrophil activation in the severity of infection with respiratory viruses through their migration toward infected lungs, and in humans infected with influenza (Brandes et al, 2013;Narasaraju et al, 2011;Zaas et al, 2009).…”

Association of Kawasaki disease with urbanization level and family characteristics in Taiwan: A nested case–control study using national-level data

“…The younger the parents are, the lower is the risk of having offspring with KD. This may be because the advanced age of parents leads to the accumulation of environmental factors, such as toxins and germline de novo variants [6,28].…”

“…Genetics, immune-mediated inflammatory process, and environmental or infectious triggers contribute to KD development [1]. Parental characteristics, especially maternal characteristics, can predict the risk of KD [5][6][7]. Maternal autoimmune disease might induce an epigenetic predisposition to KD in offspring [5].…”

“…Maternal autoimmune disease might induce an epigenetic predisposition to KD in offspring [5]. Maternal age is significantly associated with coronary artery lesion (CAL) formation in offspring with KD, and maternal age of less than 32 years reduces the incidence of CAL formation in offspring with KD [6]. A family history of allergy is significantly higher in children with KD [8].…”

CD177, a specific marker of neutrophil activation, is a hallmark of COVID-19 severity and death

“…Clinically, neutrophil chemotaxis, infiltration of endothelial cells, and extravasation into alveolar spaces have been described in lung autopsies from deceased COVID-19 patients 19 . Elevated CD177 mRNA expression has also been described for patients with acute Kawasaki Disease (KD) 42 and resistant to IV Ig therapy 43,44 , a syndrome that has been described as a possible complication of SARS-CoV-2 infection in children 45,46 . Our results are also consistent with those obtained using animal models, suggesting an important role for neutrophil activation in the severity of infection with respiratory viruses through their migration towards infected lungs, and in humans infected with influenza 47-49 .…”