Outcomes of Kawasaki disease children with spontaneous defervescence within 10 days
Journal
Frontiers in Pediatrics
Journal Volume
7
Journal Issue
APR
Date Issued
2019
Author(s)
Abstract
Background Kawasaki disease (KD) is one of the most common vasculitis in childhood. Intravenous γ-immunoglobulin (IVIG) is recommended to be administrated within 10 days after fever onset. However, some patients didn't have IVIG therapies because of atypical disease presentations or spontaneous defervescence. We aimed to evaluate the coronary outcomes of the KD patients who didn't receive IVIG and had defervescence within 10 days. Methods We retrospectively reviewed the KD patients in NTUCH between 2008 and 2015. The patients with a diagnosis of KD and had a febrile length between 5 to 10 days were enrolled. Days of fever, clinical symptoms, laboratory data at the acute stage and series of coronary artery measurements within a minimum of 3 months after disease onset were recorded. Risk factors associated with coronary lesions one month after KD onset were also analyzed. Results 293 eligible KD patients were enrolled (Male: 55.1%, mean age of onset: 1.8 years old). 37 patients had spontaneous defervescence without IVIG treatment. The incidence of coronary aneurysms at the 4th week after disease onset was higher in spontaneously defervesced KD patients than those treated with IVIG (18.9% vs. 20.3%, p = 0.002). Interestingly, of the 238 KD patients without coronary lesions at their acute phase, percentages of emerging coronary aneurysms became significantly higher if they didn't have IVIG therapies due to spontaneous defervescence (4/31), compared with those who received IVIG (3/208). Further analysis showed the development of coronary lesions at one month after disease onset was associated with younger age (< 12 months old, p = 0.024), and leukocytosis (WBC > 17,000/cumm, p = 0.031). Conclusions: 18.9% of KD patients with spontaneous defervescence had coronary aneurysms. Even without initial coronary lesions, such patients were still riskier to develop coronary aneurysms, compared with KD patients who received IVIG therapies. Such findings address the importance of refining the strategy for use of IVIG in the spontaneously defervesced KD patients within 10 days after fever onset, at least in those with age younger than one year and those with leukocytosis. ? 2019 Hu, Liu, Lin, Chen, Chiu, Lu, Chang, Wang and Wu.
SDGs
Other Subjects
aspartate aminotransferase; C reactive protein; hemoglobin; immunoglobulin; Article; aspartate aminotransferase blood level; child; clinical feature; clinical outcome; comparative study; controlled study; coronary artery; coronary artery aneurysm; coronary artery disease; female; fever; hemoglobin blood level; human; incidence; left anterior descending coronary artery; left coronary artery; leukocytosis; major clinical study; male; mucocutaneous lymph node syndrome; onset age; preschool child; retrospective study; risk factor
Publisher
Frontiers Media S.A.
Type
journal article