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. 2023 Dec 1;6(12):e2346829.
doi: 10.1001/jamanetworkopen.2023.46829.

Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children

Michael Khoury  1 , Ashraf S Harahsheh  2 , Geetha Raghuveer  3 , Nagib Dahdah  4 , Simon Lee  5 , Marianna Fabi  6 , Elif Seda Selamet Tierney  7 , Michael A Portman  8 , Nadine F Choueiter  9 , Matthew Elias  10 , Deepika Thacker  11 , Frédéric Dallaire  12 , William B Orr  13 , Tyler H Harris  14 , Kambiz Norozi  15 , Dongngan T Truong  16 , Manaswitha Khare  17 , Jacqueline R Szmuszkovicz  18 , Joseph J Pagano  1 , Cedric Manlhiot  19 , Pedrom Farid  20 , Brian W McCrindle  20 ; International Kawasaki Disease Registry
Collaborators, Affiliations

Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children

Michael Khoury et al. JAMA Netw Open. .

Abstract

Importance: Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.

Objective: To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.

Design, setting, and participants: In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.

Main outcomes and measures: Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.

Results: Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.

Conclusions and relevance: In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Harahsheh reported serving as a scientific advisory board member of OP2 DRUGS outside the submitted work. Dr Truong reported receiving grants from Pfizer and the Pediatric Heart Network outside the submitted work. Dr Szmuszkovicz reported receiving compensation as a committee member from the National Institutes of Health (NIH) outside the submitted work. Dr McCrindle reported receiving personal fees from Amryt Pharma, Chiesi, Esperion, and Ultragenyx outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart Describing the Study Cohort
AHA indicates American Heart Association; CDC, Centers for Disease Control and Prevention; IKDR, International Kawasaki Disease Registry; KD, Kawasaki disease; and MIS-C, multisystem inflammatory syndrome in children.
Figure 2.
Figure 2.. Body Mass Index/Weight z Score in Patients With Kawasaki Disease and Multisystem Inflammatory Syndrome in Children (MIS-C)
Boxes represent the IQR (first and third quartiles), with the horizontal line within each box representing the median. The horizontal lines at the end of the whiskers represent maximum and minimum values and the dots outside the whiskers represent outlier values.
Figure 3.
Figure 3.. Outcomes in Patients With Kawasaki Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) by Adiposity Category
A, Lowest LVEF was significantly lower with increasing adiposity category for patients with MIS-C (P < .001) but not KD (P = .53). B, Maximum adiposity category was not associated with maximum coronary artery z score for patients with KD or MIS-C. Boxes represent the interquartile range (first and third quartiles), with the horizontal line within each box representing the median and the dot within each box representing the mean. The horizontal lines at the end of the whiskers represent maximum and minimum values and the dots outside the whiskers represent outlier values.
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Comment in

References

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Supplementary concepts