Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age

Dooil Song, Yunku Yeo, Keesoo Ha, Giyoung Jang, Jung Hwa Lee, Kwang Chul Lee, Chang Sung Son, Joowon Lee

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. Results: While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1∈±∈3.3 vs 6.3∈±∈1.9 days, p∈=∈0.002) and showed fewer diagnostic symptoms (3.0∈±∈1.2 vs 4.3∈±∈1.1, p∈<∈0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1∈±∈10.4 vs 6.5∈±∈1.9 days, p∈=∈0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9∈±∈9.6 vs 1.1∈±∈0.8 days, p∈=∈0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR∈=∈0.494, 95% confidence interval (CI)∈=∈0.281-0.871, p∈=∈0.015) in the younger group and the duration of post-IVGG fever (OR∈=∈1.958, 95% CI∈=∈1.098-3.492, p∈=∈0.023) and the Harada score (OR∈=∈3.455, 95% CI∈=∈1.012-11.796, p∈=∈0.048) in the older group. Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.

Original languageEnglish
Pages (from-to)1315-1321
Number of pages7
JournalEuropean Journal of Pediatrics
Volume168
Issue number11
DOIs
Publication statusPublished - 2009 Jan 23

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Mucocutaneous Lymph Node Syndrome
Coronary Vessels
Fever
Cystatin C
Confidence Intervals
gamma-Globulins
Blood Sedimentation
Korea
Leukocyte Count
Bilirubin
Serum Albumin
C-Reactive Protein
Medical Records
Logistic Models
Sodium
Regression Analysis

Keywords

  • Age
  • Coronary abnormalities
  • Incomplete manifestation
  • Intravenous gamma globulin nonresponsiveness
  • Kawasaki disease
  • Risk factor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. / Song, Dooil; Yeo, Yunku; Ha, Keesoo; Jang, Giyoung; Lee, Jung Hwa; Lee, Kwang Chul; Son, Chang Sung; Lee, Joowon.

In: European Journal of Pediatrics, Vol. 168, No. 11, 23.01.2009, p. 1315-1321.

Research output: Contribution to journalArticle

Song, Dooil ; Yeo, Yunku ; Ha, Keesoo ; Jang, Giyoung ; Lee, Jung Hwa ; Lee, Kwang Chul ; Son, Chang Sung ; Lee, Joowon. / Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. In: European Journal of Pediatrics. 2009 ; Vol. 168, No. 11. pp. 1315-1321.
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abstract = "Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. Results: While the overall incidence of KD-associated CAA in our hospital was 6.7{\%}, CAA developed in 20 (12.4{\%}) of the younger group and ten (16.7{\%}) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1∈±∈3.3 vs 6.3∈±∈1.9 days, p∈=∈0.002) and showed fewer diagnostic symptoms (3.0∈±∈1.2 vs 4.3∈±∈1.1, p∈<∈0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1∈±∈10.4 vs 6.5∈±∈1.9 days, p∈=∈0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9∈±∈9.6 vs 1.1∈±∈0.8 days, p∈=∈0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR∈=∈0.494, 95{\%} confidence interval (CI)∈=∈0.281-0.871, p∈=∈0.015) in the younger group and the duration of post-IVGG fever (OR∈=∈1.958, 95{\%} CI∈=∈1.098-3.492, p∈=∈0.023) and the Harada score (OR∈=∈3.455, 95{\%} CI∈=∈1.012-11.796, p∈=∈0.048) in the older group. Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.",
keywords = "Age, Coronary abnormalities, Incomplete manifestation, Intravenous gamma globulin nonresponsiveness, Kawasaki disease, Risk factor",
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T1 - Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age

AU - Song, Dooil

AU - Yeo, Yunku

AU - Ha, Keesoo

AU - Jang, Giyoung

AU - Lee, Jung Hwa

AU - Lee, Kwang Chul

AU - Son, Chang Sung

AU - Lee, Joowon

PY - 2009/1/23

Y1 - 2009/1/23

N2 - Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. Results: While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1∈±∈3.3 vs 6.3∈±∈1.9 days, p∈=∈0.002) and showed fewer diagnostic symptoms (3.0∈±∈1.2 vs 4.3∈±∈1.1, p∈<∈0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1∈±∈10.4 vs 6.5∈±∈1.9 days, p∈=∈0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9∈±∈9.6 vs 1.1∈±∈0.8 days, p∈=∈0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR∈=∈0.494, 95% confidence interval (CI)∈=∈0.281-0.871, p∈=∈0.015) in the younger group and the duration of post-IVGG fever (OR∈=∈1.958, 95% CI∈=∈1.098-3.492, p∈=∈0.023) and the Harada score (OR∈=∈3.455, 95% CI∈=∈1.012-11.796, p∈=∈0.048) in the older group. Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.

AB - Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. Results: While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1∈±∈3.3 vs 6.3∈±∈1.9 days, p∈=∈0.002) and showed fewer diagnostic symptoms (3.0∈±∈1.2 vs 4.3∈±∈1.1, p∈<∈0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1∈±∈10.4 vs 6.5∈±∈1.9 days, p∈=∈0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9∈±∈9.6 vs 1.1∈±∈0.8 days, p∈=∈0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR∈=∈0.494, 95% confidence interval (CI)∈=∈0.281-0.871, p∈=∈0.015) in the younger group and the duration of post-IVGG fever (OR∈=∈1.958, 95% CI∈=∈1.098-3.492, p∈=∈0.023) and the Harada score (OR∈=∈3.455, 95% CI∈=∈1.012-11.796, p∈=∈0.048) in the older group. Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.

KW - Age

KW - Coronary abnormalities

KW - Incomplete manifestation

KW - Intravenous gamma globulin nonresponsiveness

KW - Kawasaki disease

KW - Risk factor

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