Abstract
Background: Coronary artery involvement is seen in approximately 15–20% of children with Kawasaki disease. There is conflicting literature regarding the clinical and laboratory findings associated with coronary artery involvement. In this retrospective study, we attempt identification of predictive factors for coronary artery involvement at our institute and review the existing literature. Methods and results: A review of 203 patients (65% males) with Kawasaki disease was performed, of whom 33 (16.3%) had coronary artery involvement. High erythrocyte sedimentation rate, high platelet count, low hematocrit, low albumin levels, and refractory Kawasaki disease showed significant association with coronary artery involvement. High erythrocyte sedimentation rate and refractory Kawasaki disease were found to be independent predictors of coronary artery involvement. Review of literature suggested a wide range of coronary involvement (<5% to >60%), and highly conflicting clinical and laboratory associations. Conclusion: It remains difficult to accurately determine risk of coronary artery involvement, although some laboratory markers may provide information that is helpful for parental counseling and clinical follow up. Future identification of novel biomarkers and host predispositions may further our understanding of coronary artery risks and help personalize therapy for Kawasaki disease.
Highlights
Coronary artery involvement is the most important complication of Kawasaki disease and is seen in approximately 15–20% of affected [1,2]
Because of the imperfect performance of scoring systems, the 2004 American Heart Association guidelines recommend that all patients diagnosed with Kawasaki disease be treated with intravenous immunoglobulin [7]
Having refractory Kawasaki disease and a high erythrocyte sedimentation rate were independently associated with coronary artery involvement
Summary
Coronary artery involvement is the most important complication of Kawasaki disease and is seen in approximately 15–20% of affected [1,2]. Past efforts at using clinical and laboratory parameters to predict coronary artery involvement in Kawasaki disease yielded inconsistent results. A number of scoring systems have attempted to guide decision-making for pharmacotherapy of Kawasaki disease based on risk of coronary artery involvement. These have not been widely adopted due to complex nature and/or low accuracy [4,5,6]. Methods and results: A review of 203 patients (65% males) with Kawasaki disease was performed, of whom 33 (16.3%) had coronary artery involvement. High platelet count, low hematocrit, low albumin levels, and refractory Kawasaki disease showed significant association with coronary artery involvement. Future identification of novel biomarkers and host predispositions may further our understanding of coronary artery risks and help personalize therapy for Kawasaki disease
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