Koki Kosami, M.D.
Research Associate
Division of Public Health, Center for Community Medicine, Jichi Medical University
Tochigi, Japan
Background:
The presentation of cardiac sequelae is important when considering the long-term prognosis of patients with a history of Kawasaki disease. Moreover, several reports indicate that the history of Kawasaki disease may contribute to the incidence of cardiovascular diseases, regardless of the presence of cardiac sequelae. However, the epidemiological evidence supporting the long-term prognosis of patients with the history of Kawasaki disease remains limited.
We conducted a prospective cohort study of 6,576 cases with the history of Kawasaki disease from 1990 through 2017. The most recent follow-up investigation commenced in 2023. The study aimed to report results from the interim analysis of the latest investigation, providing previous findings obtained from a similar study.
Methods:
We identified 6,576 patients with the history of Kawasaki disease from the nationwide Kawasaki disease surveys database in Japan, which covered the years from 1982 through 1992. These patients have been followed up using data from the Koseki system, Japanese comprehensive permanent resident registration system. The Koseki system provides information on the date and cause of each patient's death. We calculated the standardized mortality ratios (SMRs) by using national vital statistics.
Results:
The cohort consisted of 3,759 males (57%) and 2,817 females (43%). Among all patients, 1,387 (21%), 3,368 (52%), 1,592 (24%), and 126 (2%) were aged 25–29, 30–34, 35 to 39, and 40–44 years, respectively. By the end of 2017, 68 (1%) deaths were confirmed (48 males and 20 females). Of the 68 deaths, eight (12%) and 60 (88%) occurred during the acute and post-acute phases of Kawasaki disease, respectively. The expected number of deaths for the cohort was 72.0, resulting in an SMR of 0.94 (95% CI: 0.74–1.19). The SMRs for the entire observation period were not elevated for either sex. However, the SMRs were higher for both males and females with cardiac sequelae. Over half of the deaths were due to external causes.
Conclusions:
Our data indicate that patients with a history of Kawasaki disease require a long-term follow-up because most of the cohort may reach the peak age of the incidence of cardiovascular disease in the future.