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. 2024 Jun 24;11(7):ofae352.
doi: 10.1093/ofid/ofae352. eCollection 2024 Jul.

Coronary Artery Outcomes in Kawasaki Disease by Treatment Day Within 10 Days of Fever Onset

Vedika M Karandikar  1 , Huthaifah Khan  1 , Kwang-Youn A Kim  2 , Larry K Kociolek  1   3 , Ravi Jhaveri  1   3 , Stanford T Shulman  1   3 , Anne H Rowley  1   3   4
Affiliations

Coronary Artery Outcomes in Kawasaki Disease by Treatment Day Within 10 Days of Fever Onset

Vedika M Karandikar et al. Open Forum Infect Dis. .

Abstract

Background: Kawasaki disease (KD) is an acute febrile illness of childhood that can lead to coronary artery aneurysms (CAAs) and myocardial infarction. Intravenous immunoglobulin reduces the prevalence of CAA when given to patients with KD within 10 days of fever onset. Children with KD may undergo evaluation for other diagnoses before treatment, particularly those with incomplete KD criteria. If KD outcomes are improved with early treatment, a delay in treatment while evaluating for other causes might place these patients at risk.

Methods: We performed a retrospective cohort study of children treated for KD within the first 10 days of illness at our KD center from 2014 to 2021 to determine the prevalence of CAA by day of treatment.

Results: A total of 290 patients met the study criteria. No statistically significant difference was found in the odds of developing a maximum z score ≥2.5 for each day of delayed treatment within 10 days of fever onset (adjusted odds ratio, 0.87; 95% CI, .72-1.05; P = .13). Subgroup analyses by age, sex, and year of treatment did not reveal a significant association between treatment day and maximum z score ≥2.5, although the number of patients <6 months of age was small.

Conclusions: Our study supports current recommendations. We found similar odds of developing adverse coronary outcomes regardless of treatment day within 10 days from fever onset.

Keywords: Kawasaki disease; coronary artery Z-scores; coronary artery aneurysms; treatment day; treatment outcomes.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Maximum and baseline coronary artery z score by treatment day. No significant difference was found in either (A) the mean maximum z scores or (B) the mean baseline z scores by treatment day (P = .29 and P = .49, respectively). Gray shading, 95% CI. IVIG, intravenous gammaglobulin.
Figure 2.
Figure 2.
Z score vs days to first IVIG treatment by age and sex. No significant differences were found in either (A) the mean baseline z scores or (C) the mean maximum z scores by treatment day when grouped by sex. No differences were identified in either (B) the mean baseline z scores or (D) the mean maximum z scores by treatment day within 3 age groups: ≥6 months and <1 year, ≥1 and <8 years, and ≥8 years. No conclusions could be drawn for the <6-month age group due to the small number of patients. Gray shading, 95% CI. IVIG, intravenous gammaglobulin.
Figure 3.
Figure 3.
Treatment day and maximum z score in classic and incomplete KD. A, Patients with classic KD were treated at a mean of day 7, while those with incomplete KD were treated at a mean of day 8. B, Patients with classic and incomplete KD presentations had similar maximum z scores by treatment day. Gray shading, 95% CI. IVIG, intravenous gammaglobulin; KD, Kawasaki disease.
Figure 4.
Figure 4.
Cumulative distribution of day from fever onset to intravenous gammaglobulin treatment. Similar cumulative distributions of days from fever onset to treatment were seen between patients who had a maximum z score <2.5 and those with a maximum z score ≥2.5.
See this image and copyright information in PMC

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