Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease

Dionne, Audrey; Bucholz, Emily M.; Gould, Patrick; Son, Mary Beth; Baker, Annette L.; Ferranti, Sarah D. de; Fulton, David R.; Friedman, Kevin G.

doi:10.1016/j.jpeds.2019.05.024

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…However, approximately 10 % of KD children might develop to both initial and repeated IVIG resistance [6], and often require additional interventions, such as corticosteroid, infliximab, plasma exchange and cytotoxic agents [7]. An intensified initial rescue therapy may reduce the occurrence of repeated IVIG resistance, but whether apply to every resistant KD child is controversial when taking into account potential adverse outcomes and the economic cost of the treatment [8][9][10]. It seems more reasonable to consider intensified therapy if KD children with repeated IVIG resistance,that have high risk of coronary artery aneurysm (CAA) [11].…”

Section: Introductionmentioning

confidence: 99%

Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

et al. 2021

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Background Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. Methods A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. Conclusions Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.

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Section: Introductionmentioning

confidence: 99%

Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

et al. 2021

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“…It is also worth noting that the association of prolonged hospitalization with low SES was also remarkable for non-EV-A71-infected HFMD inpatients. The reason could be that doctors may postpone discharge out of concerns about incompetent parental monitoring of lower-SES families and their limited medical resource accessibility, irrespective of EV serotypes [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Clinical Severity With Family Affluence–Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study

Wang

Liu

et al. 2021

Open Forum Infectious Diseases

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Background The association between the clinical severity of HFMD inpatients and socioeconomic status (SES) is important for quantifying SES inequality in HFMD disease burden and informing decision-makers regarding medical subsidy and reimbursement policies. Here, this association was investigated using a quantitative SES measurement. Methods Laboratory-confirmed HFMD cases hospitalized at Henan Children’s Hospital from February 15, 2017 to February 15, 2018 were invited. We utilized the revised Family Affluence Scale for family-affluence-based SES measurement. Clinical severity was diagnosed based on central nervous system (CNS) complications, treatments and length of stay. We applied logistic regression for association analyses and multiple imputation for missing data. Results A total of 1229 laboratory-confirmed HFMD inpatients responded. Adjusted by age, sex, rural residence, EV-A71 infection and health-seeking behavior, CNS complications (OR=2.72, 95%CI: 1.41-5.31), ICU admission (OR=7.30, 95%CI: 2.21-25.97) and prolonged hospitalization (OR=4.28, 95%CI: 2.44-7.58) were significantly associated with lower family-affluence-based SES. These associations increased as SES category descended. For EV-A71-infected inpatients, severe HFMD was significantly associated with low and intermediate SES. For non-EV-A71-infected inpatients, only the association of prolonged hospitalization with low SES increased significantly. Also, severe HFMD inpatients, especially those admitted to ICU, incurred high hospitalization costs. Conclusions The clinical severity of HMFD inpatients was significantly associated with family-affluence-based SES. Severe HFMD inpatients were more likely to have lower SES than non-severe inpatients and suffered heavy economic burden. Therefore, medical subsidy and reimbursement policies should offer sufficient monetary support to severe HFMD inpatients, to alleviate economic burden of low-SES populations and reduce potential SES inequality.

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“…Compared with Caucasian children, African American children with KD have more severe inflammation and extended hospitalizations ( 65 ). Previous reports attributed these racial disparities to differences in socioeconomic and environmental factors ( 66 ). However, these disparities may also be due to genetic differences ( 67 ), including variations in the mitochondrial genome.…”

Section: Racial and Ethnic Disparitiesmentioning

confidence: 99%

The role of mitochondria in the pathogenesis of Kawasaki disease

Beckley¹,

Shrestha

Singh

et al. 2022

Front. Immunol.

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Kawasaki disease is a systemic vasculitis, especially of the coronary arteries, affecting children. Despite extensive research, much is still unknown about the principal driver behind the amplified inflammatory response. We propose mitochondria may play a critical role. Mitochondria serve as a central hub, influencing energy generation, cell proliferation, and bioenergetics. Regulation of these biological processes, however, comes at a price. Release of mitochondrial DNA into the cytoplasm acts as damage-associated molecular patterns, initiating the development of inflammation. As a source of reactive oxygen species, they facilitate activation of the NLRP3 inflammasome. Kawasaki disease involves many of these inflammatory pathways. Progressive mitochondrial dysfunction alters the activity of immune cells and may play a role in the pathogenesis of Kawasaki disease. Because they contain their own genome, mitochondria are susceptible to mutation which can propagate their dysfunction and immunostimulatory potential. Population-specific variants in mitochondrial DNA have also been linked to racial disparities in disease risk and treatment response. Our objective is to critically examine the current literature of mitochondria’s role in coordinating proinflammatory signaling pathways, focusing on potential mitochondrial dysfunction in Kawasaki disease. No association between impaired mitochondrial function and Kawasaki disease exists, but we suggest a relationship between the two. We hypothesize a framework of mitochondrial determinants that may contribute to ethnic/racial disparities in the progression of Kawasaki disease.

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Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease

Cited by 12 publications

References 34 publications

Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

Association of Clinical Severity With Family Affluence–Based Socioeconomic Status Among Hospitalized Pediatric Hand, Foot, and Mouth Disease Patients in Henan, China: A Single Hospital-Based Case Series Study

The role of mitochondria in the pathogenesis of Kawasaki disease

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