Factors Predisposing to the Coronary Artery Risk in Kawasaki Disease

Abstract

To assess predisposing factors of coronary artery abnormalities(CAA) in Kawasaki disease, clinical records of patients with a discharge diagnosis of Kawasaki disease at Korea University Medical Center from 1999 to 2001 were reviewed. A total of 99 patients were diagnosed and 11 patients developed CAA (11%). Variable factors including clinical manifestations, laboratory measurements, treatment and its responses were evaluated to predict CAA. Sixty five patients met complete American Heart Association (AHA) criteria (typical KD) whereas 34 patients did not (atypical KD). CAA were developed in 5 of typical KD compared to 6 of atypical KD (7.7% vs 17.6%). Intravenous immune globulin (IVIG) were administrated in 91 patients and 9 of them developed CAA compared to 2 of 8 who did not received IVIG (10% vs 25%). When the IVIG responsiveness was defined by the presence or absence of defervescence within 5 days after IVIG therapy, 75 were IVIG-responsive and 16 were not. Six in the IVIG-responsive group developed CAA compared to 3 in the IVIG-non-responsive group (8% vs 19%). A total of 62 patients were male and 8 of them developed CAA compared to 3 of 34 female patients (13% vs 8%). Total duration of fever, a duration of fever before the initiation of IVIG and the level of C-reactive protein (CRP) at onset were significantly higher (p=0.0018, p=0.0095, p=0.002) and the hemoglobin level at onset was significantly lower in CAA group (p=0.0009). Conclusively, predisposing factors of CAA in Kawasaki disease are male gender, atypical manifestations, no IVIG therapy, no IVIG-responsiveness, longer duration of total fever, longer duration of fever before the initiation of IVIG, the higher level of CRP and the lower level of hemoglobin at onset.