Abstract
ObjectiveThe aims of this study were to characterize the evolution of routine blood values within the first 10 days of illness and coronary artery outcome in infants < 8 months with Kawasaki disease (KD) and to identify risk factors for coronary artery aneurysm (CAA).MethodsLaboratory data, clinical features and coronary artery outcomes from 78 infants < 8 months old and 86 patients between 8 months and 7 years old were retrospectively analyzed. Logistic regression analysis was conducted to evaluate the potential risk factors for CAA.ResultsInfants < 8 months old were more likely to present with incomplete KD (37.2% vs 4.7%, P < 0.001), erythema and induration at the BCG inoculation site (24.4% vs 3.5%, P < 0.001) and CAA (47.4% vs 15.1%, P < 0.001) even with timely diagnosis and treatment with intravenous immunoglobulin (IVIG) compared with patients ≥8 months old. Clinical feature related to diagnostic criteria for KD including bilateral conjunctival injection, oral changes, unilateral cervical lymphadenopathy and extremity changes were less common in the younger group. During the acute phase, the percentage neutrophils and neutrophil to lymphocyte ratio [NLR] peaked on median illness day 3, followed by white blood cell (WBC) and CRP on median illness day 4, hemoglobin on median illness day 7 and platelet count on median illness day 9. CAA occurred on median illness day 6 and regressed on median illness day 28. Multivariate logistic regression analysis revealed that the peak percentage neutrophils (odds ratio [OR] per 0.1: 1.597, 95% confidence interval [CI]: 1.041–2.452, P = 0.032) and the peak platelet count (OR per 10 × 109/L: 1.029, 95% CI: 1.004–1.055, P = 0.024) were independent risk factors for CAA. Hemoglobin on the 5th day was associated with persistent CAA at 1 year after KD onset.ConclusionFactors associated with CAA include a high peak percentage neutrophils, increased peak platelet count, and reduced hemoglobin within 4–6 days during the acute phase of KD. Therefore, this population should receive primary therapy with IVIG and adjunctive anti-inflammatory medications.
Highlights
Kawasaki disease (KD) is an acute systemic vasculitis of unknown cause that preferentially affects the coronary artery [1]
coronary artery aneurysm (CAA) occurred on median illness day 6 (IQR: 5–8, range 1–33)
The data of this study showed that 37.2% of infants younger than 8 months had incomplete KD, 47.4% of these infants had CAA, and 9.0% had persistent CAA at 1 year after KD onset
Summary
Kawasaki disease (KD) is an acute systemic vasculitis of unknown cause that preferentially affects the coronary artery [1]. The most frequent age at onset of KD ranges from 9 to 11 months, and an onset age younger than 6 months is relatively infrequent [2]. Infants, especially those younger than 6 months, are reported to have. The aims of this study were to characterize the dynamic change of laboratory values within the first 10 days of illness and the coronary artery outcome in infants younger than 8 months with KD, and to describe the use of laboratory data to identify risk factors for coronary aneurysms in this population
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