The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
51
Journal Issue
3
Pages
321-331
Date Issued
2018
Author(s)
Abstract
Objective: The use of corticosteroid in Kawasaki disease (KD) remains controversial among current guidelines. The objective of this study is to summarize the effectiveness and safety of corticosteroid to prevent coronary arterial lesions in Kawasaki disease, both as initial and rescue therapy. Methods: The Medline, EMBASE, Google scholar, Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov, and Japanese Institutional Repositories Online were searched for studies up to 31 March 2017. Studies that compared incidence of coronary artery lesions between regimens with corticosteroid and regimen without it in a well-defined controlled group were included. The incidence of coronary artery lesion was analyzed by meta-analysis. Results: Nineteen studies published between 1999 and 2016 fulfilled eligibility criteria. There were 3591 patients included for analysis. There was a significant reduction in incidence of coronary artery lesions with usage of corticosteroid with a pooled odds ratio of 0.72 (95% CI 0.57–0.92; p = 0.01) than that without usage of corticosteroid. In general, a greater effect was seen in the patient received corticosteroid as initial and adjuvant therapy with intravenous immune globulin (pooled odds ratio 0.39, 95% CI 0.21–0.73, p = 0.007) than those who received corticosteroid as rescue therapy. The risk reduction was statistically significant in Japanese groups (OR 0.56, 95% CI 0.42–0.75 in fixed effects model) but not significant in non-Japanese groups (OR 1.45, 95% CI 0.91–2.30 in fixed effects model). Conclusions: We demonstrated an overall reduction in incidence of coronary artery lesions with the use of corticosteroid as initial and adjuvant treatment for Kawasaki disease. ? 2017
SDGs
Other Subjects
corticosteroid; dexamethasone; immunoglobulin; methylprednisolone; corticosteroid; immunoglobulin; adjuvant therapy; artery lesion; Article; attributable risk; bibliographic database; cardiovascular risk; comparative study; coronary artery disease; corticosteroid therapy; drug efficacy; echocardiography; heart catheterization; human; incidence; Japanese (people); meta analysis; mucocutaneous lymph node syndrome; practice guideline; risk reduction; systematic review; complication; coronary artery disease; factual database; meta analysis (topic); mucocutaneous lymph node syndrome; Adrenal Cortex Hormones; Coronary Artery Disease; Databases, Factual; Humans; Immunoglobulins, Intravenous; Incidence; Meta-Analysis as Topic; Mucocutaneous Lymph Node Syndrome
Publisher
Elsevier Ltd
Type
journal article