17 - CLINICAL CHARACTERISTICS OF KAWASAKI DISEASE IN ADOLESCENTS

Background: Incomplete KD, which can cause coronary artery complications due to delayed diagnosis, is common in infants or school-age and adolescents. Although many studies have been conducted on infant KD, KD in older ages, especially adolescents, has not been studied much. Therefore, through this study, the authors aimed to determine the clinical characteristics and risk of coronary artery complications in adolescent patients with KD.

Methods: This study used the nationwide survey data between 2009 and 2017 in South Korea. Patients were divided into 4 categories on the basis of their age at diagnosis, that is, < 1 year, 1 to 4 years, 5 to 9 years, and 5 to 9 years, and ≥ 10 years of age. We analyzed the clinical symptoms, laboratory findings, treatment and coronary complications depend on age group.

Results: A total of 37,423 patients were included, and 8,610 (23.0 %) were aged < 1 year, 24,318 (65.0 %) were 1 to 4 years, 4,225 (11.3 %) were 5 to 9 years, 270 (0.7 %) were ≥ 10 years. (Table 1) 

 In patients with KD ≥ 10 years of age had higher proportion of males (vs 1–5 years, P=0.011; vs 5–9 years, P=0.034), longer fever duration (vs all other groups, P< 0.001), more incidence of incomplete KD (vs 1–5 years, P< 0.001; vs 5–9 years, P=0.036), less typical symptoms (see Table 1, P< 0.001) and Bacillus Calmette-Guérin site erythema (vs < 1 year and vs 1–5 years, P< 0.001) than younger groups. In laboratory findings, KD ≥ 10 years of age had higher neutrophil proportion (vs < 1 year, P< 0.001; vs 1–5 years, P=0.004), lower platelet count (vs all other groups, P< 0.001) and less pyuria (vs < 1 year, P< 0.001; vs 1–5 years, P=0.001) than younger groups. Although there was significant difference only in comparison with KD < 1 year (P < 0.001), the non-responder to IVIG treatment was common in KD ≥ 10 years of age. Coronary dilatation and aneurysm were more frequent in KD ≥ 10 years of age (see Table 1, P< 0.001), but there was no difference in coronary artery occlusion, myocardial ischemia, and death compared to younger groups.

Conclusion: Older children have different clinical and laboratory characteristics than usual and younger age KD. Considering the high incidence of coronary artery lesions in adolescent KD patients, there is a need to be more active diagnosis and treatment.