Abstract
Background and Objectives: Most cases of Kawasaki disease (KD) occur between the ages of 6 months and 5 years. Differences in immunological reaction and CAL (coronary artery lesion) by the age subgroups classified according to the prevalence of KD and those particularly in the earlier life of KD should be investigated. Materials and Methods: The laboratory data of 223 infantile and 681 non-infantile KD cases from 2003 to 2018 at Korea University Hospital were retrospectively analyzed. Patients with KD were divided into infants and non-infants and further subdivided into four subgroups by age. The age-adjusted Z-values were compared among the subgroups. Febrile controls were identified as patients with fever for >5 days and who showed some of the KD symptoms. Results: IVIG (intravenous immunoglobulin) resistance at the age of 6 months or less was significantly lower than that at the ages of 7–12 months and 13–60 months (respectively, p < 0.05). The significant risk factors for CAL in total KD patients were age, incomplete KD, post-IVIG fever, IVIG resistance, convalescent Z-eosinophil, and subacute platelet (p < 0.05). The significant risk factors for CAL at the age of 6 months or less were IVIG resistance, acute Z-neutrophil, subacute Z-neutrophil, subacute NLR (neutrophil to lymphocyte ratio), and subacute platelet (respectively, p < 0.05). Conclusion: Younger age and incomplete presentation in KD can be independent risk factors for CAL. The immune reactions of KD at a younger age are more tolerated compared with those at older ages during the acute phase. The immune response at the age of 6 months or less showed immune tolerance in terms of incomplete presentation and IVIG responsiveness. The risk factors such as IVIG resistance, subacute platelet, subacute NLR, and acute or subacute Z-neutrophil at the age of 6 months or less can be very useful parameters to predict CAL in young, incomplete KD.
Highlights
IntroductionInfants with Kawasaki disease (KD) in the first year of life ( in the first 6 months) have more frequent cardiac sequelae and greater morbidity than older children [1]
Infants with Kawasaki disease (KD) in the first year of life have more frequent cardiac sequelae and greater morbidity than older children [1]
The hematological Z-value can be a useful standard parameter through which to understand the chronological changes of white blood cell (WBC) and red blood cell (RBC) counts according to age, one limitation is that ethnic differences may be present [5]
Summary
Infants with Kawasaki disease (KD) in the first year of life ( in the first 6 months) have more frequent cardiac sequelae and greater morbidity than older children [1]. Our previous investigation showed that the risk of CAL in infantile KD throughout all phases was highly associated with lower Z-hemoglobin and thrombocytosis compared with non-infantile KD [5]. It is necessary to investigate whether there are differences in immunological reaction and CAL by the age subgroups classified according to the prevalence of KD, and it is important to detect latent. Most cases of Kawasaki disease (KD) occur between the ages of 6 months and 5 years. Differences in immunological reaction and CAL (coronary artery lesion) by the age subgroups classified according to the prevalence of KD and those in the earlier life of KD should be investigated. Febrile controls were identified as patients with fever for >5 days and who showed some of the KD symptoms
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