COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry

Jerin Jose^{1

2}, Elif Seda Selamet Tierney³, Ashraf S Harahsheh⁴, Nagib Dahdah⁵, Geetha Raghuveer⁶, Kevin G Friedman⁷, Michael Khoury⁸, Mark D Hicar⁹, Shae A Merves¹⁰, Frederic Dallaire¹¹, Pedrom Farid¹², Cedric Manlhiot¹², Kyle Runeckles¹³, Nilanjana Misra¹⁴, Michael Portman¹⁵, Jean A Ballweg¹⁶, Simon Lee¹⁷, Supriya S Jain¹⁸, Tyler H Harris¹⁹, Jacqueline R Szmuszkovicz²⁰, William Orr²¹, Guillermo Larios²², Brian W McCrindle¹²

Affiliations

¹ Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. jtj17@alumni.utsw.edu.
² , 535 Everett Ave, Apt 101, Palo Alto, CA, 94301, USA. jtj17@alumni.utsw.edu.
³ Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
⁴ Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
⁵ Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Canada.
⁶ Children's Mercy Hospital, Kansas City, MO, USA.
⁷ Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
⁹ Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
¹⁰ University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA.
¹¹ Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹² Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹³ Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, ON, Canada.
¹⁴ Cohen Children's Medical Center of NY, Northwell Health, Queens, NY, USA.
¹⁵ Seattle Children's Hospital, Seattle, WA, USA.
¹⁶ Children's Hospital & Medical Center of Omaha, Omaha, NE, USA.
¹⁷ The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
¹⁸ New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
¹⁹ UPMC Children's Hospital of Pittsburgh, University of Pittsburgh SOM, Pittsburgh, PA, USA.
²⁰ Children's Hospital of Los Angeles, Los Angeles, CA, USA.
²¹ Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, USA.
²² Pontificia Universidad Católica de Chile, Región Metropolitana, Santiago, Chile.

PMID: 36786810
PMCID: PMC9926414
DOI: 10.1007/s00246-023-03109-w

COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry

Jerin Jose et al. Pediatr Cardiol. 2023 Aug.

. 2023 Aug;44(6):1373-1381.

doi: 10.1007/s00246-023-03109-w. Epub 2023 Feb 14.

Authors

Affiliations

¹ Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. jtj17@alumni.utsw.edu.
² , 535 Everett Ave, Apt 101, Palo Alto, CA, 94301, USA. jtj17@alumni.utsw.edu.
³ Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
⁴ Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
⁵ Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Canada.
⁶ Children's Mercy Hospital, Kansas City, MO, USA.
⁷ Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
⁹ Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
¹⁰ University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA.
¹¹ Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹² Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹³ Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, ON, Canada.
¹⁴ Cohen Children's Medical Center of NY, Northwell Health, Queens, NY, USA.
¹⁵ Seattle Children's Hospital, Seattle, WA, USA.
¹⁶ Children's Hospital & Medical Center of Omaha, Omaha, NE, USA.
¹⁷ The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
¹⁸ New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
¹⁹ UPMC Children's Hospital of Pittsburgh, University of Pittsburgh SOM, Pittsburgh, PA, USA.
²⁰ Children's Hospital of Los Angeles, Los Angeles, CA, USA.
²¹ Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, USA.
²² Pontificia Universidad Católica de Chile, Región Metropolitana, Santiago, Chile.

PMID: 36786810
PMCID: PMC9926414
DOI: 10.1007/s00246-023-03109-w

Abstract

To determine clinical differences for children with complete Kawasaki disease (KD) with and without evidence of preceding SARS-CoV-2 infection. From January 2020, contemporaneous patients with complete KD criteria were classified as either SARS-CoV-2 positive (KDCOVID+; confirmed household exposure, positive PCR and/or serology) or SARS-CoV-2 negative (KDCOVID-; negative testing and no exposure) and compared. Of 744 patients in the International Kawasaki Disease Registry, 52 were KDCOVID- and 61 were KDCOVID+. KDCOVID+ patients were older (median 5.5 vs. 3.7 years; p < 0.001), and all additionally met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C). They were more likely to have abdominal pain (60% vs. 35%; p = 0.008) and headache (38% vs. 10%; p < 0.001) and had significantly higher CRP, troponin, and BUN/creatinine, and lower hemoglobin, platelets, and lymphocytes. KDCOVID+ patients were more likely to have shock (41% vs. 6%; p < 0.001), ICU admission (62% vs. 10%; p < 0.001), lower left ventricular ejection fraction (mean lowest LVEF 53% vs. 60%; p < 0.001), and to have received inotropic support (60% vs. 10%; p < 0.001). Both groups received IVIG (2 doses in 22% vs. 18%; p = 0.63), but KDCOVID+ were more likely to have received steroids (85% vs. 35%; p < 0.001) and anakinra (60% vs. 10%; p = 0.002). KDCOVID- patients were more likely to have medium/large coronary artery aneurysms (CAA, 12% vs. 0%; p = 0.01). KDCOVID+ patients differ from KDCOVID-, have more severe disease, and greater evidence of myocardial involvement and cardiovascular dysfunction rather than CAA. These patients may be a distinct KD phenotype in the presence of a prevalent specific trigger.

Keywords: COVID-19; Kawasaki; MIS-C; MIS-C with KD phenotype; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

**Fig. 2**
Maximum coronary artery Z score category by group. CA coronary artery, KD Kawasaki disease

See this image and copyright information in PMC

References

1. CDC (2021) Multisystem inflammatory syndrome (MIS). Published 2021. https://www.cdc.gov/mis/hcp/index.html. Accessed 1 Mar 2022
1. Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. J Am Med Assoc. 2020;324(3):259–269. doi: 10.1001/jama.2020.10369. - DOI - PMC - PubMed
1. Cheung EW, Zachariah P, Gorelik M, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. J Am Med Assoc. 2020;324(3):294–296. doi: 10.1001/jama.2020.10374. - DOI - PMC - PubMed
1. States U, July M, Godfred-cato S, et al. COVID-19-related multisystem inflammatory syndrome in children. AAP Gd Rounds. 2020;44(3):30–30. doi: 10.1542/gr.44-3-30. - DOI
1. Harahsheh AS, Dahdah N, Newburger JW, et al. Missed or delayed diagnosis of Kawasaki disease during the 2019 novel coronavirus disease (COVID-19) pandemic. J Pediatr. 2020;222(July):261–262. doi: 10.1016/j.jpeds.2020.04.052. - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Supplementary concepts

Actions

Grants and funding

R01HL143130/National Institutes of Health

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry

Affiliations

COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Supplementary concepts

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous