Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017.

Li-Ping Xie,Mei-Rong Huang,Wei-Li Yan,Guo-Ying Huang,Sun Chen,Min Huang,Fang Liu

doi:10.2188/jea.je20190065

Abstract

BackgroundWe sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL).MethodsAs in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL.ResultsA total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL.ConclusionsThe incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.

Highlights

Kawasaki disease (KD) is an acute, self-limited febrile illness that predominantly affects children under 5 years of age
We aimed to provide the descriptive epidemiology of KD in Shanghai from 2013 through 2017 and identify independent risk factors for coronary artery lesions (CAL)
All patients discharged from these hospitals from January 1, 2013 through December 31, 2017 with an International Classification of Diseases (ICD) code for KD or mucocutaneous lymph node syndrome (ICD9 446.1 and ICD10 M30.3) were enrolled

Summary

Introduction

Kawasaki disease (KD) is an acute, self-limited febrile illness that predominantly affects children under 5 years of age. It is a systemic vasculitis mainly affecting coronary arteries[1] and is becoming the leading cause of childhood acquired heart disease both in developed countries and China.[2]. The incidence of KD remains highest in Japan,[3] followed by South Korea,[4] Taiwan,[5] and mainland China,[6,7] whereas it was much lower in European[8] and American countries.[9,10] the incidence of KD has recently shown an increasing trend in many regions, especially in Asian countries.[3,4,5,7] In Shanghai, a well-developed city in China, the incidence of KD increased from 16.8 to 55.5 per 100,000 children

Objectives

Methods

Results

Conclusion