Non-coronary cardiac events, younger age, and IVIG unresponsiveness increase the risk for coronary aneurysms in Italian
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ORIGINAL ARTICLE
Non-coronary cardiac events, younger age, and IVIG unresponsiveness increase the risk for coronary aneurysms in Italian children with Kawasaki disease Marianna Fabi 1 & Laura Andreozzi 1 & Ilaria Frabboni 1 & Ada Dormi 2 & Elena Corinaldesi 3 & Francesca Lami 4 & Cristina Cicero 5 & Bertrand Tchana 6 & Rosa Francavilla 7 & Monica Sprocati 8 & Barbara Bigucci 9 & Claudia Balsamo 10 & Paola Sogno Valin 11 & Giorgia Di Fazzio 12 & Lorenzo Iughetti 4 & Enrico Valletta 13 & Federico Marchetti 14 & Andrea Donti 15 & Marcello Lanari 1 Received: 29 February 2020 / Revised: 27 July 2020 / Accepted: 4 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objectives Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children in high-income countries because of coronary artery involvement. Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. Methods Multicenter retrospective and prospective study including 372 consecutive children (58% boys; mean age 34.3 ± 30.3 months, Caucasian 85%) was diagnosed with KD. We divided the cohort into 2 groups according to the presence of coronary anomalies (CAA) and aneurysms. We compared the groups and studied the risk factors for CAA and for aneurysms, the most severe lesions. Results Children with CAA were 91/372 (24.46%, aneurysms 20/372, 5.37%). Children with CAA were more likely to have a longer duration of fever (p < 0.001), later day of treatment (p < 0.001), to be IVIG non-responders and late treated (p < 0.001), while age, clinical presentation, and seasonality were not different. They also had significantly higher WBC and neutrophils, lower lymphocytes, Hb and Na during the acute stage, and slower resolution of inflammation. Age, IVIG unresponsiveness, and presence of non-coronary cardiac findings were independent risk factors for CAA and for aneurysms, while neutrophils just for CAA. Age under 6 months was a risk factor for the aneurysm. Aneurysms occurred more frequently in the first quartile of the age of KD onset (under 14 months).
* Marianna Fabi [email protected] 1
Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy
2
Department of Medical and Surgical Science, DIMEC, University of Bologna, Bologna, Italy
3
Department of Pediatrics, Ramazzini Hospital, Carpi, Italy
4
Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
7
Department of Pediatrics, Maggiore Hospital, Bologna, Italy
8
Department of Pediatrics, Arcispedale Sant’Anna, Ferrara, Italy
9
Department of Pediatrics, Infermi Hospital, Rimini, Italy
10
Department of Pediatrics, Bufalini Hospital, Cesena, Italy
11
Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
12
Department of Pediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
13
Department of Pe
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