Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin

Tetsuhiro Kibata, Yasuo Suzuki, Shunji Hasegawa, Takeshi Matsushige, Takeshi Kusuda, Madoka Hoshide, Kazumasa Takahashi, Seigo Okada, Hiroyuki Wakiguchi, Tadashi Moriwake, Masashi Uchida, Noriko Ohbuchi, Takashi Iwai, Masanari Hasegawa, Kiyoshi Ichihara, Mayumi Yashiro, Nobuko Makino, Yosikazu Nakamura, Shoichi Ohga

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Backgrounds Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. Methods Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24 months). Results The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7% to 23% during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0%) was higher than that in those who did not (14/1450; 0.97%, p = 2.0 × 10 - 35 ). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7% vs. 5/194; 2.6%, p = 8.9 × 10 - 10 ). Multivariate analyses indicated corticosteroid therapy (p < 0.0001), hyperbilirubinemia (p = 0.0010), and a longer number of days before treatment (p = 0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. Conclusions IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.

Original languageEnglish
Pages (from-to)209-215
Number of pages7
JournalInternational Journal of Cardiology
Volume214
DOIs
Publication statusPublished - Jul 1 2016
Externally publishedYes

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Mucocutaneous Lymph Node Syndrome
Intravenous Immunoglobulins
Immunoglobulins
Coronary Vessels
Adrenal Cortex Hormones
Incidence
Systemic Vasculitis
Hyperbilirubinemia
Therapeutics
Medical Records
Japan
Multivariate Analysis
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin. / Kibata, Tetsuhiro; Suzuki, Yasuo; Hasegawa, Shunji; Matsushige, Takeshi; Kusuda, Takeshi; Hoshide, Madoka; Takahashi, Kazumasa; Okada, Seigo; Wakiguchi, Hiroyuki; Moriwake, Tadashi; Uchida, Masashi; Ohbuchi, Noriko; Iwai, Takashi; Hasegawa, Masanari; Ichihara, Kiyoshi; Yashiro, Mayumi; Makino, Nobuko; Nakamura, Yosikazu; Ohga, Shoichi.

In: International Journal of Cardiology, Vol. 214, 01.07.2016, p. 209-215.

Research output: Contribution to journalArticle

Kibata, T, Suzuki, Y, Hasegawa, S, Matsushige, T, Kusuda, T, Hoshide, M, Takahashi, K, Okada, S, Wakiguchi, H, Moriwake, T, Uchida, M, Ohbuchi, N, Iwai, T, Hasegawa, M, Ichihara, K, Yashiro, M, Makino, N, Nakamura, Y & Ohga, S 2016, 'Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin', International Journal of Cardiology, vol. 214, pp. 209-215. https://doi.org/10.1016/j.ijcard.2016.03.017
Kibata, Tetsuhiro ; Suzuki, Yasuo ; Hasegawa, Shunji ; Matsushige, Takeshi ; Kusuda, Takeshi ; Hoshide, Madoka ; Takahashi, Kazumasa ; Okada, Seigo ; Wakiguchi, Hiroyuki ; Moriwake, Tadashi ; Uchida, Masashi ; Ohbuchi, Noriko ; Iwai, Takashi ; Hasegawa, Masanari ; Ichihara, Kiyoshi ; Yashiro, Mayumi ; Makino, Nobuko ; Nakamura, Yosikazu ; Ohga, Shoichi. / Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin. In: International Journal of Cardiology. 2016 ; Vol. 214. pp. 209-215.
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abstract = "Backgrounds Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. Methods Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24 months). Results The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7{\%} to 23{\%} during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0{\%}) was higher than that in those who did not (14/1450; 0.97{\%}, p = 2.0 × 10 - 35 ). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7{\%} vs. 5/194; 2.6{\%}, p = 8.9 × 10 - 10 ). Multivariate analyses indicated corticosteroid therapy (p < 0.0001), hyperbilirubinemia (p = 0.0010), and a longer number of days before treatment (p = 0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. Conclusions IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.",
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AU - Kibata, Tetsuhiro

AU - Suzuki, Yasuo

AU - Hasegawa, Shunji

AU - Matsushige, Takeshi

AU - Kusuda, Takeshi

AU - Hoshide, Madoka

AU - Takahashi, Kazumasa

AU - Okada, Seigo

AU - Wakiguchi, Hiroyuki

AU - Moriwake, Tadashi

AU - Uchida, Masashi

AU - Ohbuchi, Noriko

AU - Iwai, Takashi

AU - Hasegawa, Masanari

AU - Ichihara, Kiyoshi

AU - Yashiro, Mayumi

AU - Makino, Nobuko

AU - Nakamura, Yosikazu

AU - Ohga, Shoichi

PY - 2016/7/1

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N2 - Backgrounds Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. Methods Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24 months). Results The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7% to 23% during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0%) was higher than that in those who did not (14/1450; 0.97%, p = 2.0 × 10 - 35 ). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7% vs. 5/194; 2.6%, p = 8.9 × 10 - 10 ). Multivariate analyses indicated corticosteroid therapy (p < 0.0001), hyperbilirubinemia (p = 0.0010), and a longer number of days before treatment (p = 0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. Conclusions IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.

AB - Backgrounds Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. Methods Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24 months). Results The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7% to 23% during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0%) was higher than that in those who did not (14/1450; 0.97%, p = 2.0 × 10 - 35 ). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7% vs. 5/194; 2.6%, p = 8.9 × 10 - 10 ). Multivariate analyses indicated corticosteroid therapy (p < 0.0001), hyperbilirubinemia (p = 0.0010), and a longer number of days before treatment (p = 0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. Conclusions IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.

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