Cargando…
Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan
IMPORTANCE: Initial intravenous immunoglobulin (IVIG)–refractory status and prolonged fever are established risk factors for the development of coronary artery abnormalities (CAAs) among patients with acute-phase Kawasaki disease (KD). However, whether different risk factors exist for initial unresp...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194667/ https://www.ncbi.nlm.nih.gov/pubmed/35696166 http://dx.doi.org/10.1001/jamanetworkopen.2022.16642 |
_version_ | 1784726776989089792 |
---|---|
author | Takekoshi, Nobuhito Kitano, Naomi Takeuchi, Takashi Suenaga, Tomohiro Kakimoto, Nobuyuki Suzuki, Takayuki Kada, Tomoya Tsuchihashi Shibuta, Shoichi Tachibana, Shinya Murayama, Yuri Yamaga, Hironobu Suzuki, Hiroyuki |
author_facet | Takekoshi, Nobuhito Kitano, Naomi Takeuchi, Takashi Suenaga, Tomohiro Kakimoto, Nobuyuki Suzuki, Takayuki Kada, Tomoya Tsuchihashi Shibuta, Shoichi Tachibana, Shinya Murayama, Yuri Yamaga, Hironobu Suzuki, Hiroyuki |
author_sort | Takekoshi, Nobuhito |
collection | PubMed |
description | IMPORTANCE: Initial intravenous immunoglobulin (IVIG)–refractory status and prolonged fever are established risk factors for the development of coronary artery abnormalities (CAAs) among patients with acute-phase Kawasaki disease (KD). However, whether different risk factors exist for initial unresponsiveness to IVIG and CAA development remains unclear. OBJECTIVE: To evaluate whether different risk factors exist for initial unresponsiveness to IVIG and CAA development among patients with KD (stratified by age at disease onset). DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a consecutive sample of 2414 patients from a database of patients with KD from October 1, 1999, to September 30, 2019. The data were based on annual surveys (response rate, 100%) using hospital medical records across Wakayama Prefecture, Japan. Data were analyzed from March 6 to March 26, 2022. EXPOSURES: The patient’s age and diagnosis of KD by board-certified pediatricians using the criteria established by the Japan KD Research Committee. MAIN OUTCOMES AND MEASURES: Initial unresponsiveness to IVIG, defined as treatment with optional or advanced therapies, and development of CAAs. Echocardiograms performed 1 month after KD onset using the Japanese Ministry of Health criteria evaluated the presence or absence of CAAs. Odds ratios (ORs) with 95% CIs of patient age at KD onset for unresponsiveness to IVIG and developing CAAs were calculated using multivariable logistic regression models. RESULTS: A total of 2414 patients (1403 male patients [58.1%]; median age at onset of KD, 25 months [range, 1-212 months]) were included in the study: 550 younger than 12 months, 1342 aged 12 to 47 months, and 522 older than 47 months. A total of 535 patients (22.2%) received optional or advanced treatment and 68 patients (2.8%) developed CAAs 1 month after disease onset. The sex-adjusted OR among patients younger than 12 months for unresponsiveness to IVIG was 0.77 (95% CI, 0.59-0.99) and for development of CAAs was 1.94 (95% CI, 1.07-3.52); among those older than 47 months, the OR for unresponsiveness to IVIG was 1.32 (95% CI, 1.05-1.67) and for development of CAAs was 2.47 (95% CI, 1.39-4.39). After adjusting for IVIG administration, ORs among boys older than 47 months for unresponsiveness to IVIG was 1.14 (95% CI, 0.84-1.56) and for development of CAAs was 2.15 (95% CI, 1.08-4.30); among girls younger than 12 months, the OR for unresponsiveness to IVIG was 1.02 (95% CI, 0.65-1.60) and for development of CAAs was 3.79 (95% CI, 1.21-11.90). CONCLUSIONS AND RELEVANCE: The results of this study suggest that risks of unresponsiveness to IVIG and the development of CAAs differ between infants with KD and older patients with KD. Residual risk factors for KD-related CAAs other than initial unresponsiveness to IVIG should be addressed, particularly in infants. |
format | Online Article Text |
id | pubmed-9194667 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-91946672022-07-05 Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan Takekoshi, Nobuhito Kitano, Naomi Takeuchi, Takashi Suenaga, Tomohiro Kakimoto, Nobuyuki Suzuki, Takayuki Kada, Tomoya Tsuchihashi Shibuta, Shoichi Tachibana, Shinya Murayama, Yuri Yamaga, Hironobu Suzuki, Hiroyuki JAMA Netw Open Original Investigation IMPORTANCE: Initial intravenous immunoglobulin (IVIG)–refractory status and prolonged fever are established risk factors for the development of coronary artery abnormalities (CAAs) among patients with acute-phase Kawasaki disease (KD). However, whether different risk factors exist for initial unresponsiveness to IVIG and CAA development remains unclear. OBJECTIVE: To evaluate whether different risk factors exist for initial unresponsiveness to IVIG and CAA development among patients with KD (stratified by age at disease onset). DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a consecutive sample of 2414 patients from a database of patients with KD from October 1, 1999, to September 30, 2019. The data were based on annual surveys (response rate, 100%) using hospital medical records across Wakayama Prefecture, Japan. Data were analyzed from March 6 to March 26, 2022. EXPOSURES: The patient’s age and diagnosis of KD by board-certified pediatricians using the criteria established by the Japan KD Research Committee. MAIN OUTCOMES AND MEASURES: Initial unresponsiveness to IVIG, defined as treatment with optional or advanced therapies, and development of CAAs. Echocardiograms performed 1 month after KD onset using the Japanese Ministry of Health criteria evaluated the presence or absence of CAAs. Odds ratios (ORs) with 95% CIs of patient age at KD onset for unresponsiveness to IVIG and developing CAAs were calculated using multivariable logistic regression models. RESULTS: A total of 2414 patients (1403 male patients [58.1%]; median age at onset of KD, 25 months [range, 1-212 months]) were included in the study: 550 younger than 12 months, 1342 aged 12 to 47 months, and 522 older than 47 months. A total of 535 patients (22.2%) received optional or advanced treatment and 68 patients (2.8%) developed CAAs 1 month after disease onset. The sex-adjusted OR among patients younger than 12 months for unresponsiveness to IVIG was 0.77 (95% CI, 0.59-0.99) and for development of CAAs was 1.94 (95% CI, 1.07-3.52); among those older than 47 months, the OR for unresponsiveness to IVIG was 1.32 (95% CI, 1.05-1.67) and for development of CAAs was 2.47 (95% CI, 1.39-4.39). After adjusting for IVIG administration, ORs among boys older than 47 months for unresponsiveness to IVIG was 1.14 (95% CI, 0.84-1.56) and for development of CAAs was 2.15 (95% CI, 1.08-4.30); among girls younger than 12 months, the OR for unresponsiveness to IVIG was 1.02 (95% CI, 0.65-1.60) and for development of CAAs was 3.79 (95% CI, 1.21-11.90). CONCLUSIONS AND RELEVANCE: The results of this study suggest that risks of unresponsiveness to IVIG and the development of CAAs differ between infants with KD and older patients with KD. Residual risk factors for KD-related CAAs other than initial unresponsiveness to IVIG should be addressed, particularly in infants. American Medical Association 2022-06-13 /pmc/articles/PMC9194667/ /pubmed/35696166 http://dx.doi.org/10.1001/jamanetworkopen.2022.16642 Text en Copyright 2022 Takekoshi N et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Takekoshi, Nobuhito Kitano, Naomi Takeuchi, Takashi Suenaga, Tomohiro Kakimoto, Nobuyuki Suzuki, Takayuki Kada, Tomoya Tsuchihashi Shibuta, Shoichi Tachibana, Shinya Murayama, Yuri Yamaga, Hironobu Suzuki, Hiroyuki Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title | Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title_full | Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title_fullStr | Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title_full_unstemmed | Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title_short | Analysis of Age, Sex, Lack of Response to Intravenous Immunoglobulin, and Development of Coronary Artery Abnormalities in Children With Kawasaki Disease in Japan |
title_sort | analysis of age, sex, lack of response to intravenous immunoglobulin, and development of coronary artery abnormalities in children with kawasaki disease in japan |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194667/ https://www.ncbi.nlm.nih.gov/pubmed/35696166 http://dx.doi.org/10.1001/jamanetworkopen.2022.16642 |
work_keys_str_mv | AT takekoshinobuhito analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT kitanonaomi analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT takeuchitakashi analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT suenagatomohiro analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT kakimotonobuyuki analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT suzukitakayuki analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT kadatomoyatsuchihashi analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT shibutashoichi analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT tachibanashinya analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT murayamayuri analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT yamagahironobu analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan AT suzukihiroyuki analysisofagesexlackofresponsetointravenousimmunoglobulinanddevelopmentofcoronaryarteryabnormalitiesinchildrenwithkawasakidiseaseinjapan |