Clinical Management
Vedika M. Karandikar, MHS
Medical Student
UConn School of Medicine
Farmington, Connecticut, United States
Background/
Aim: A current controversy in KD is whether outcomes are better if IVIG treatment is given by the 7th day rather than the 10th day of illness. If validated by other studies, a change in treatment recommendations might be warranted.
Methods: We performed a retrospective cohort study of children treated for KD within the first 10 days of illness at our KD center at the Ann & Robert H. Lurie Children’s Hospital of Chicago from 2014 to 2021. Children who received IVIG treatment for KD 4-10 days after fever onset were included in the study. Our main outcome was the prevalence of CA Aneurysms by day of treatment as defined by the development of a max z-score ≥2.5 for the left anterior descending artery and/or right coronary artery. We also evaluated baseline z-score by day of IVIG treatment. One-way ANOVA tests were used to evaluate for differences in the max z-scores and baseline z-scores across treatment days. Logistic regression analysis was used to evaluate the association between day of treatment and a max z-score ≥2.5.
Results: 290 patients met the study criteria. The mean max z-score among all patients included in the study was 1.9 and the mean baseline z-score was 1.2. We did not find a significant difference in either the mean max z-scores or mean baseline z-scores between treatment days. (p=0.29 and p=0.49, respectively). No statistically significant difference was found in the odds of developing a max z-score ≥2.5 by day of treatment within ten days of fever onset (adjusted OR 0.87, 95% CI 0.72-1.05, p=0.13). Zmax ≥2.5 occurred in 23.5% of those treated on day 4-7 and 19% of those treated on day 8-10. The results were the same when controlling for age and sex. However, the number of patients < 6 months of age per treatment day was small and a conclusion regarding this age group could not be made.
Conclusion: Our findings support current recommendations that treatment for KD be administered by the 10th day after fever onset, or sooner if the diagnosis is established. Evaluation of children with possible Kawasaki disease for other diagnoses at our center did not appear to pose undue risk for adverse coronary artery outcomes as long as IVIG treatment was administered within the first 10 days of illness.