Treatment Intensification in Patients With Kawasaki Disease and Coronary Aneurysm at Diagnosis

Dionne, Audrey; Burns, Jane C.; Dahdah, Nagib; Tremoulet, Adriana H.; Gauvreau, Kimberlee; Ferranti, Sarah D. de; Baker, Annette L.; Son, Mary Beth F.; Gould, Patrick; Fournier, Anne; Newburger, Jane W.; Friedman, Kevin G.

doi:10.1542/peds.2018-3341

Cited by 64 publications

(39 citation statements)

References 28 publications

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“…The regimen included initial treatment with IVIG and aspirin, with the addition of corticosteroid therapy for those with shock or at greater risk of coronary artery aneurysm. 12 Biological modifying medication was also given to those who were unresponsive to IVIG and corticosteroids. 13 This treatment protocol was associated with rapid clinical improvement and reduction in inflammatory markers in most patients, with no mortality.…”

Section: Discussionmentioning

confidence: 99%

Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection

Capone

Subramony

Sweberg

et al. 2020

The Journal of Pediatrics

230

404

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Section: Discussionmentioning

confidence: 99%

Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection

Capone

Subramony

Sweberg

et al. 2020

The Journal of Pediatrics

230

404

View full text Add to dashboard Cite

show abstract

“…Son et al developed the risk scores for predicting coronary artery aneurysms in a north American population and validated the score including baseline Z score ≥ 2.0, age < 6 months, Asian race, and C-reactive protein (CRP) ≥ 13 mg/dL [24]. Dionne et al recently showed that adjunctive corticosteroid therapy with IVIG may be protective against progression of coronary artery aneurysms based on Son's score [25]. Tremoulet et al developed a scoring system for predicting coronary artery aneurysms: illness days ≤ 4 days, 1 point; bands ≥ 20%, 2 points; γglutamyl transpeptidase ≥ 60 U/L, 1 point; age-adjusted hemoglobin concentrations ≤ − 2, 1 point [26].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio and scoring system for predicting coronary artery lesions of Kawasaki disease

et al. 2020

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Background: Kawasaki disease (KD) causes coronary artery lesions (CAL) and is the leading cause of acquired heart disease in children. The aim of this study is to evaluate the risk factors and setup a scoring system for predicting CAL of KD. Methods: We retrospectively reviewed a total of 478 patients diagnosed with KD. We compared age, gender, laboratory data, and treatment response in two groups and developed a scoring system for predicting CAL. Results: During the study period, 365 of these patients had complete medical records of coronary surveys by echocardiography. Anemia, hypoalbuminemia, C reactive protein (CRP), alanine aminotransferase, neutrophil count, and neutrophil/lymphocyte ratio (NLR) showed significant differences with CAL formation. We determined the cutoff value using a receiver-operating-characteristic (ROC) curve, and following multivariate logistic regression analysis, four independent risk factors demonstrated a significant difference with CAL formation, including CRP > 103 mg/L, NLR > 3.5, male gender, and intravenous immunoglobulin (IVIG) resistance. We established a score system based on the above evaluation, for which a ROC curve was performed, and a total score of ≥ 2 points showed a sensitivity of 60.8% and a specificity of 70.6%, with an area under the ROC curve of 0.696. Conclusions: Identifying children at risk is important in order to prevent CAL from developing. Four independent risk factors that can predict CAL formation were CRP > 103 mg/L, NLR > 3.5, male gender, and IVIG resistance. This first report incorporated NLR into score systems to predict CAL reinforces previously well-known risk factors for the CAL formation among KD patients.

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“…Although the uncommon presentation of KD in this newborn may have prompted clinicians to consider other medium vessel vasculitides such as polyarteritis nodosa, the efficacy of IVIG and favorable prognosis led us to believe that KD was the most appropriate diagnosis for this patient. In terms of initial therapy, corticosteroids are often used in addition to IVIG in high-risk patients or those with CAAs at diagnosis, and they have been proven to have a favorable long-term effect on CAAs [17]. Considering the early age of onset and multiple aneurysms in this patient, anticoagulation with LMWH or warfarin was added to aspirin for more aggressive prophylaxis of thrombosis, which is also a class IIb recommendation of the 2017 AHA guidelines for medium CAAs [12].…”

Section: Discussionmentioning

confidence: 99%

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

Zhao

Liang

et al. 2020

Pediatr Rheumatol

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Background: Kawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates. Case presentation: A male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children's hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively. Conclusion: This unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.

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Treatment Intensification in Patients With Kawasaki Disease and Coronary Aneurysm at Diagnosis

Cited by 64 publications

References 28 publications

Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection

Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection

Neutrophil-to-lymphocyte ratio and scoring system for predicting coronary artery lesions of Kawasaki disease

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

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