Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease

Abstract

Kawasaki disease (KD) is an acute, systemic, febrile vasculitis that occurs during infancy and is the most common cause of childhood coronary artery disease. 1 Although, its etiology has not been definitively determined, recent studies have focused on the increased inflammatory cytokines in KD pathology. 2-4 The clinical features include an existence of fever persisting more than five days with mucocutaneous and lymphatic manifestations that are commonly self-limiting. However, the most serious complication is the coronary artery involvement that can be mortal. With the routine use of intravenous immunoglobulin (IVIG) treatment, the incidence of coronary artery lesions (CALs) has declined from 23% to 8%. 5 On the other hand, some patients are at risk for resistance to IVIG treatment and development of CALs. 6 In Turkey, KD was reported as the second most common type of vasculitis in a nationwide study by Ozen et al. 7 , despite the real prevalence being unknown. Previous studies about KD from Turkey reported higher prevalence of coronary arterial involvement than Japanese children based studies. 8-12 Many studies have previously been conducted about the risk factors of KD, and patients with atypical age presentation, elevated acute phase reactants and liver function tests were reported as high risk. 10-12 The Japanese-based risk scoring systems such as that by Kobayashi, Egami, and Sano was reported as inadequate for fully determining the risks for IVIG resistance and CALs in Western populations living in North

Prominent gallbladder enlargement: Kawasaki disease or other congenital or acquired gallbladder disease? A case report

“…Whether the coronary artery becomes damaged is related to many factors, such as the severity of inflammation, age, sex, opportunity to undergo IVIG therapy, and genetic background. 15 – 17 The inflammatory reaction in the present case was serious, but there was no coronary dilatation; this might have been related to the patient’s low-risk age, timely use of IVIG treatment, and good response to anti-inflammatory treatment. GB distension is reportedly not a significant risk factor for coronary artery dilatation.…”

Prediction Model Risk-of-Bias Assessment Tool for coronary artery lesions in Kawasaki disease

“…Most studies included used logistic regression. One study used discrimination analysis ( 13 ), while two ( 17 , 23 ) used multivariable analysis. Only one study used machine learning methods.…”

Differentially expressed genes, lncRNAs, and competing endogenous RNAs in Kawasaki disease

“…Delayed diagnosis and treatment for KD may cause prolonged inflammation of vessel walls and a high risk for IVIG resistance and a high rate of CALs (Lech et al, 2019;Rigante, 2020;Türkuçar et al, 2020). Also, clinical variables, including the levels of platelet-derived microparticles, platelet count, and neutrophil count were associated with CALs (Chen et al, 2011;Hu et al, 2020;Jin et al, 2019).…”