Kawasaki disease: Review of risk factors for coronary aneurysms

Koren, Gideon; Lavi, Sasson; Rose, Vera; Rowe, Richard D.

doi:10.1016/s0022-3476(86)80878-2

Cited by 135 publications

(68 citation statements)

References 9 publications

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“…[86][87][88][89] Duration of fever, presumably reflecting the severity of ongoing vasculitis, has been confirmed as a powerful predictor of coronary artery aneurysms in various studies. [87][88][89] Harada et al 90,91 developed a risk score to use at the time a child presents with Kawasaki disease to determine the risk of future coronary aneurysms. At some centers in Japan, the Harada score is used to determine whether IVIG treatment will be used.…”

Section: Risk Scores For Predicting Aneurysmsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Pediatrics

1,693

2,533

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ABSTRACT. Background. Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ϳ15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.Methods and Results. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for >5 days and <4 classic criteria should undergo electrocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-␣ antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.Conclusions. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients. Pediatrics

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Section: Risk Scores For Predicting Aneurysmsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Pediatrics

1,693

2,533

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“…(2) In an echocardiographic study, 17 CAL appeared at around 10 illness days. (3) In a clinical study, 11 patients with CAL had a significantly higher temperature than those without CAL during 10-13 illness days. Since additional IVGG appeared to be safe without apparent adverse effects, 4 we suggest that it should be administered before the first 10 febrile days to initial IVGG non-responders.…”

Section: Discussionmentioning

confidence: 94%

“…This is probably because physicians are inclined to give additional IVGG to patients who appeared more ill and were believed to be at high risk for CAL. 1 Furthermore, we suspect that a delayed start of additional IVGG may fail to prevent CAL, since prolonged fever is a powerful predictor of CAL; 11 however, few previous studies [1][2][3][4][5][6] have referred to the number of febrile days before start of the additional IVGG infusion. We therefore focused on KD patients treated with additional IVGG owing to unresponsiveness to initial IVGG, and studied the risk factors for CAL to test a hypothesis that additional IVGG therapy, if administered early, may decrease the prevalence of CAL.…”

mentioning

confidence: 99%

Coronary risk factors in Kawasaki disease treated with additional gammaglobulin

Miura¹

2004

Archives of Disease in Childhood

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Aims: To assess the hypothesis that an additional intravenous gammaglobulin (IVGG) infusion, if administered early, may prevent coronary artery lesions (CAL) in patients with Kawasaki disease (KD) who do not respond to initial IVGG therapy. Methods: Forty four KD patients (17 with CAL and 27 without CAL), treated with additional IVGG because of persistent or recrudescent fever after initial IVGG therapy, were studied. Main outcome measures were the presence of CAL by echocardiography and the number of febrile days before and after start of additional IVGG infusion (pre-and post-additional IVGG). Results: In univariate analyses, risk factors for CAL were the number of febrile days pre-additional IVGG, the number of febrile days post-additional IVGG, the number of days that initial IVGG was divided over, the white blood cell count pre-and post-additional IVGG, and the C reactive protein concentration preadditional IVGG. In a multivariate analysis, the only independent risk factor was the number of febrile days pre-additional IVGG (>10 days; odds ratio 7.86; 95% CI 1.44 to 42.8; p = 0.02). Conclusions: Among KD patients with persistent or recrudescent fever after initial IVGG therapy, administration of additional IVGG before the first 10 febrile days was associated with a decreased prevalence of CAL, when compared with the prevalence in those who were retreated later. An additional IVGG infusion, if administered early, may prevent CAL in initial IVGG non-responders.A pproximately 10-20% of patients with acute Kawasaki disease (KD) do not respond to standard intravenous gammaglobulin (IVGG) therapy and have persistent or recrudescent fever after completion of the infusion.

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“…86 -89 Duration of fever, presumably reflecting the severity of ongoing vasculitis, has been confirmed as a powerful predictor of coronary artery aneurysms in various studies. [87][88][89] Harada et al 90,91 developed a risk score to use at the time a child presents with Kawasaki disease to determine the risk of future coronary aneurysms. At some centers in Japan, the Harada score is used to determine whether IVIG treatment will be used.…”

Section: Risk Scores For Predicting Aneurysmsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,602

818

View full text Add to dashboard Cite

Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

show abstract

Kawasaki disease: Review of risk factors for coronary aneurysms

Cited by 135 publications

References 9 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Coronary risk factors in Kawasaki disease treated with additional gammaglobulin

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

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