Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis

• Published in: The Journal of pediatrics Vol. 243; pp. 167 - 172.e1
• Main Authors: van Stijn, Diana, Korbee, Justin M., Netea, Stejara A., de Winter, Vera C., Zwinderman, Koos A.H., Kuipers, Irene M., Kuijpers, Taco W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022
• Subjects: Coronary Aneurysm - etiology; Coronary Artery Disease; Coronary Vessels - diagnostic imaging; Humans; Immunoglobulins, Intravenous - therapeutic use; Infant; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - drug therapy; Retrospective Studies; Risk Assessment; IVIG; CAA
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2021.12.054

To assess whether ‘treatment day’ is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG). Patient data from (n = 1016) a single center were collected for an observational cohort study. After exclusions, we retrospectively analyzed 776 patients in total. A multivariate analysis was performed with treatment day as a continuous variable (n = 691). Patients were categorized as no enlargement, small CAA, medium CAA, and giant CAA. Late treatment per-day was a significant predicting factor for the development of larger CAAs. ORs for medium and giant CAAs per delayed day were 1.1 (95% CI 1.1-1.2) P < .05 and 1.2 (95% CI 1.1-1.2) P < .05, respectively. We showed that every day of delay in treatment of patients with Kawasaki disease inherently carries a risk of medium and giant aneurysm formation. There was no cut-off point for treatment day that could mark a safe zone.