Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017

Abstract

Background We sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL). Methods As in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL. Results A total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL. Conclusions The incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.

Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India

“…neutrophil-platelet aggregates, platelet-derived microparticles, platelet VEGF levels, betathromboglobulin levels, PF4 levels, and platelet CD62P expression) are also elevated in acute phase of KD (7-13). Our study had a high proportion of children with incomplete KD (35.7%), which is in line with other recent studies from Asia (16,17). Median duration of fever in our cohort of children with KD was 13.5 days that is higher compared to the European and North American cohorts (18,19).…”

Clinical Implications of Procalcitonin in Kawasaki Disease: A Useful Candidate For Differentiating From Sepsis and Evaluating IVIG Responsiveness

“…Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limited febrile illness and predominantly affects the cardiovascular system in young children less than 5 years of age. According to a recent epidemiological survey, an increasing trend in the incidence of KD has been noticed in China, with almost a one-fold increase from 50.5 per 100,000 children in 2008 to 94.7 per 100,000 children in 2017 [1,2]. Dependent on the 2017 American Heart Association (AHA) guidelines, the diagnostic criteria of KD include fever ≥ 5 days combined with at least 4 of the 5 principal clinical features.…”

“…High-dose intravenous immunoglobulin (IVIG) plus aspirin is the rst-line treatment for not only suppressing systemic in ammation in the acute episode of KD but also decreasing the incidence of CAAs to 6.8% [5]. However, approximately 10-20% of KD patients still have recrudescent or persistent fever at least 36 hours after completion of the initial IVIG infusion and are termed IVIG non-responders [2,4]. To date, the accurate etiology of KD remains unknown, and recent consensus is that an infectious trigger, exaggerated immune response and in ammatory cascades may occur in genetically susceptible children who subsequently develop KD.…”

Assessment of coronary artery abnormalities and variability of Z‐score calculation in the acute episode of Kawasaki disease—A retrospective study from China

“…Kawasaki disease (KD) is a systemic vasculitis and mainly affects Asian children <5 years of age. In a latest epidemiological study from Shanghai, China, the average annual incidence rate of KD was 94.7 per 100 000 children aged <5 years since 2013‐2017 1 . Coronary artery abnormalities (CAAs) secondary to KD are the leading cause of acquired heart disease in childhood and represent the major contributors to prognosis in the long term.…”