Clinical Management
Marianna Fabi, n/a
Medical doctor, PhD
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
Bologna, Emilia-Romagna, Italy
Background
Coronary artery lesions (CALs) developed during acute KD can regress or persist later. Chronic CALs are associated with significant risk for cardiovascular morbidity and life-threatening events. Several clinical scores have been proposed to predict the risk for developing CAA and to adequate therapeutic strategies in Asian and American population.
Methods
Data of KD patients from 10 Italian sites were registered into a centralized RedCap database. KD was diagnosed according to AHA definition. Persistent CALs (pCALs) were defined as the persistency of CALs after 6-8 weeks from the diagnosis. Clinical, demographic and laboratory features of patients with pCALs were analyzed and compared with those who did not develop CALs. Multiple logistic regression was used to identify independent risk factors for pCALs.
Results
517 children were enrolled (Caucasian 87.4%). pCALs were found in 52/517 patients (10.2%, boys 12.03% vs girls 6.97, p=0.06) and all were present during the acute stage. pCALs were more prevalent in Asian (26,9%, p: 0.026), younger patients presenting with skin rash (61,5%, p: 0.05) and incomplete clinical presentation (p=0.03). pCALs developed more frequently in summer, but seasonality didn’t significantly impact on pCALs prevalence. Abdominal ultrasound was performed in 132/517 patients: pathological features were associated with pCALs (p=0.04).Children with pCALs have higher white blood cells and CRP
Male gender, age younger than 6 months, Asian ethnicity, fever longer than 10 days, incomplete presentation, CRP >13 mg >dl were independent risk factors for pCALs.
Compared with independent risk factors for acute CALs, the age is younger (6 versus 18 months), while hemoglobin < 10.3 g/l looses its statistical power in patients with pCALs.
Conclusions
In our mostly Caucasian population, younger age, sex, Asian ethnicity, longer duration of fever, incomplete presentation and high CRP are independent risk factors for persistence of CALs. Compared to patients with transient CALs, the cut-off of the age as independent risk factor is smaller and low hemoglobin does not impact.