Risk Factors of Coronary Involvement in Kawasaki Disease in Recent Outbreak in South Iran, Shiraz.

Yıl 2012, Cilt: 4 Sayı: 4, 1 - 7, 03.12.2012

Hamid Amoozgar , Hamid Mohammadi Nader Shakibazad

Öz

Background: During the past year, Kawasaki disease (KD) had an outbreak with a high inci-dence of coronary involvement in Shiraz, Iran. This study focuses on risk factors and their correlation with aneurysm formation.

Methods: All patients who were admitted with the diagnosis of KD in the pediatric units of Shiraz, Iran between 2009 and 2010 were included in this study. Data analysis was performed on demographic as well as clinical features, laboratory data, echocardiography, and electrocardiogram as well as treatment details.

Results: The population under study included 45 patients, 25 males (55.6%) and 20 females (44.4%), with the mean age of 3.52 ± 2.77 years. Aneurysm was seen in 10 cases (22.2%) with the male to female ratio of 9:1. The most important risk factor of aneurysm formation was the male gender with the odds ratio of 10.6. Age more than 8 years was a very specific but non-sensitive predictor of aneurysm formation (sensitivity: 40% and specificity: 100%). Platelet counts more than 424×103 was the most sensitive predictor of aneurysm formation (sensitivity: 90% and specificity: 57.1%). Fever duration more than 10 days had the sensitivity of 60% and the specificity of 88.6% for developing coronary aneurysm. No significant difference was seen in other clinical symptoms and laboratory data including complete blood count, liver function test, renal function test, electrolyte, and ECG data.

Conclusion: Male gender, older age, prolong fever before treatment, and higher platelet counts were the risk factors of coronary aneurysm in KD. More education for early diagnosis of Kawa-saki disease in older patients is highly recommended.

Anahtar Kelimeler

Kawasaki, Aneurysm, Coronary Artery, Risk Factor, Delayed diagnosis

Kaynakça

• Asadi-Pooya AA, Borzoee M, Amoozgar H. The experience with 113 patients with Kawasaki disease in Fars Province, Iran. Turk J Pediatr. 2006;48(2):109-14.
• Yanagawa H, Nakamura Y, Yashiro M, Uehara R, Oki I, Kayaba K. Incidence of Kawasaki disease in Japan: the nationwide surveys of 1999-2002. Pediatr Int. 2006; 48: 356-61.
• E.J T. Complications of Kawasaki disease. Current Paediatrics. 2005;15(1):62-8.
• Suzuki A, Tizard EJ, Gooch V, Dillon MJ, Haworth SG. Kawasaki disease: echocardiographic features in 91 cases presenting in the United Kingdom. Arch Dis Child. 1990;65(10):1142-6.
• Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long- term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-71.
• Juan CC, Hwang B, Lee PC, Lin YJ, Chien JC, Lee HY, et al. The clinical manifestations and risk factors of a delayed diagnosis of Kawasaki disease. J Chin Med Assoc. 2007;70(9):374-9.
• Kim DS. Kawasaki disease. Yonsei Med J. 2006;47(6):759-72.
• Asai T. Diagnosis and prognosis of coronary artery lesions in Kawasaki disease. Coronary angiography and the conditions for its application (a score chart). Nihon Rinsho. 1983;41(9):2080-5.
• Moradinejad MH, Kiani A. Kawasaki Disease in 159 Iranian Children. Iran J Ped. 2007;17(3):241-6.
• Pierre R, Sue-Ho R, Watson D. Kawasaki syndrome in Jamaica. Pediatr Infect Dis J. 2000;19(6):539-43.
• Royle JA, Williams K, Elliott E, Sholler G, Nolan T, Allen R, et al. Kawasaki disease in Australia, 1993-95. Arch Dis Child. 1998;78(1):33-9.
• Nakamura Y, Yanagawa H. The worldwide epidemiology of Kawasaki disease. Progress in Pediatric Cardiology. 2004;19(2):99-108.
• Zhang T, Yanagawa H, Oki I, Nakamura Y. Factors relating to the cardiac sequelae of Kawasaki disease one month after initial onset. Acta Paediatr. 2002;91:517-20.
• Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16:178-222. 15- Davaalkham D, Nakamura Y, Baigalmaa D, Davaa G, Chimedsuren O, Sumberzul N, et al. Kawasaki disease in Mongolia: results from 2 nationwide retrospective surveys, 1996-2008. J Epidemiol. 2011;21(4):293-8.
• Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr. 2007;166(5):421-5.
• Honkanen VE, McCrindle BW, Laxer RM, Feldman BM, Schneider R, Silverman ED. Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cardiol. 2003;24(2):122-6.