Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group.

Autor: Fernandez-Cooke E; Department of Pediatrics, Hospital Universitario Doce de Octubre, Madrid, Spain., Barrios Tascón A; Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain., Sánchez-Manubens J; Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain.; Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain., Antón J; Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain., Grasa Lozano CD; Department of Pediatrics, Hospital Universitario Doce de Octubre, Madrid, Spain., Aracil Santos J; Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain., Villalobos Pinto E; Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain., Clemente Garulo D; Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain., Mercader Rodríguez B; Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain., Bustillo Alonso M; Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain., Nuñez Cuadros E; Department of Pediatrics, Hospital Regional Universitario de Malaga, Andalucia, Spain., Navarro Gómez ML; Department of Pediatrics, Hospital Universitario Gregorio Marañon, Madrid, Spain., Domínguez-Rodríguez S; Fundación de Investigación Hospital 12 Octubre (Madrid, Spain), Fondazione PENTA ONLUS, Padova, Italy., Calvo C; Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 May 20; Vol. 14 (5), pp. e0215665. Date of Electronic Publication: 2019 May 20 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0215665
Abstrakt: Background: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children.
Objective: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain.
Methods: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals).
Results: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms.
Conclusions: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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