Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Changes of clinical characteristics and outcomes in patients with Kawasaki disease over the past 7 years in a single center study

  • Kang, Hye Jin (Department of Pediatrics, Chungnam National University School of Medicine) ;
  • Kim, Gee Na (Department of Pediatrics, Inje University Pusan Paik Hospital, Inje University College of Medicine) ;
  • Kil, Hong Ryang (Department of Pediatrics, Chungnam National University School of Medicine)
  • Received : 2013.02.12
  • Accepted : 2013.07.08
  • Published : 2013.09.15
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Abstract

Purpose: This single-center study was conducted to assess the changes in epidemiological and clinical characteristics and outcomes of patients with Kawasaki disease (KD) over the past 7 years. Methods: This retrospective study included 135 children with KD, admitted to Chungnam National University Hospital, Daejeon, between 2004 and 2005 (group A, n=53) and between 2011 and 2012 (group B, n=82). Medical records were reviewed to obtain information regarding the presenting signs and symptoms, demographic characteristics, and laboratory and echocardiographic findings associated with KD. Results: The hospital admission date after onset was significantly earlier in group B than in group A (P=0.008). The proportion of patients with incomplete KD was 45.3% and 65.9% in group A and B, respectively (P=0.018). The number of pretreatment coronary artery lesions (CALs) were significantly lesser in group B than in group A. (10/53 vs. 5/82, P=0.021). No significant differences was observed in the incidence of CALs at discharge, febrile phase duration, hospital stay duration, incidence of retreatment, and intravenous immunoglobulin dose between 2 groups. The total febrile phase was shorter in patients with incomplete KD than in those with complete KD in both groups. Conclusion: The proportion of incomplete KD has become higher. Furthermore, early admission and management of patients with KD may be related to increased incomplete KD and decreased CALs. Therefore, we believe that a diagnostic strategy for incomplete KD should be established regardless of the presence of coronary lesions.

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References

  1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  2. Abstracts of the 10th International Kawasaki Disease Symposium. February 7-10, 2012. Kyoto, Japan. Pediatr Int 2012;54 Suppl 1:38-142. https://doi.org/10.1111/j.1442-200X.2012.03534.x
  3. Kim GB, Han JW, Hong YM. Epidemiological features of Kawasaki disease in Korea, 2009-2011. The 56th Annual Scientific Meeting of the Korean Society of Cardiology; 2012 Nov 16-17; Daejeon, Korea.
  4. Nakamura Y, Yashiro M, Uehara R, Sadakane A, Chihara I, Aoyama Y, et al. Epidemiologic features of Kawasaki disease in Japan: results of the 2007-2008 nationwide survey. J Epidemiol 2010;20:302-7. https://doi.org/10.2188/jea.JE20090180
  5. Juan CC, Hwang B, Lee PC, Lin YJ, Chien JC, Lee HY, et al. The clinical manifestations and risk factors of a delayed diagnosis of Kawasaki disease. J Chin Med Assoc 2007;70:374-9. https://doi.org/10.1016/S1726-4901(08)70023-6
  6. Sudo D, Monobe Y, Yashiro M, Mieno MN, Uehara R, Tsuchiya K, et al. Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan. Eur J Pediatr 2012;171:651-6. https://doi.org/10.1007/s00431-011-1630-3
  7. Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS. Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 2012;171:657-62. https://doi.org/10.1007/s00431-011-1631-2
  8. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 2005;47:232-4. https://doi.org/10.1111/j.1442-200x.2005.02033.x
  9. Park MY, Lee KY, Han JW, Lee HS, Hong JH, Whang KT. Laboratory values in patients with Kawasaki disease after intravenous immunoglobulin: comparison of patients with coronary artery lesions to those without coronary artery lesions. J Korean Pediatr Soc 2003;46:162-6.
  10. Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991;33:805-10. https://doi.org/10.1111/j.1442-200X.1991.tb02612.x
  11. Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  12. Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006;149:237-40. https://doi.org/10.1016/j.jpeds.2006.03.050
  13. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998;133:254-8. https://doi.org/10.1016/S0022-3476(98)70229-X
  14. Heuclin T, Dubos F, Hue V, Godart F, Francart C, Vincent P, et al. Increased detection rate of Kawasaki disease using new diagnostic algorithm, including early use of echocardiography. J Pediatr 2009;155:695-9.e1. https://doi.org/10.1016/j.jpeds.2009.04.058
  15. Ghelani SJ, Sable C, Wiedermann BL, Spurney CF. Increased incidence of incomplete Kawasaki disease at a pediatric hospital after publication of the 2004 American Heart Association guidelines. Pediatr Cardiol 2012;33:1097-103. https://doi.org/10.1007/s00246-012-0232-9
  16. Fukushige J, Takahashi N, Ueda Y, Ueda K. Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 1994;83: 1057-60. https://doi.org/10.1111/j.1651-2227.1994.tb12985.x
  17. Joffe A, Kabani A, Jadavji T. Atypical and complicated Kawasaki disease in infants. Do we need criteria? West J Med 1995;162:322-7.
  18. Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age. J Pediatr 1995;126:524-9. https://doi.org/10.1016/S0022-3476(95)70344-6
  19. Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007;166:131-7.
  20. Son MB, Gauvreau K, Ma L, Baker AL, Sundel RP, Fulton DR, et al. Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006. Pediatrics 2009;124:1-8. https://doi.org/10.1542/peds.2008-0730
  21. Park YW, Park IS, Kim CH, Ma JS, Lee SB, Kim CH, et al. Epidemiologic study of Kawasaki disease in Korea, 1997-1999: comparison with previous studies during 1991-1996. J Korean Med Sci 2002;17:453-6. https://doi.org/10.3346/jkms.2002.17.4.453
  22. Park YW, Han JW, Park IS, Kim CH, Cha SH, Ma JS, et al. Kawasaki disease in Korea, 2003-2005. Pediatr Infect Dis J 2007;26:821-3. https://doi.org/10.1097/INF.0b013e318124aa1a
  23. Chang FY, Hwang B, Chen SJ, Lee PC, Meng CC, Lu JH. Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis J 2006;25:241-4. https://doi.org/10.1097/01.inf.0000202067.50975.90
  24. Tseng CF, Fu YC, Fu LS, Betau H, Chi CS. Clinical spectrum of Kawasaki disease in infants. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64:168-73.
  25. Perrin L, Letierce A, Guitton C, Tran TA, Lambert V, Kone-Paut I. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine 2009;76:481-5. https://doi.org/10.1016/j.jbspin.2008.11.015

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