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Association Between Dose of Glucocorticoids and Coronary Artery Lesions in Kawasaki Disease
Author(s) -
Okubo Yusuke,
Michihata Nobuaki,
Morisaki Naho,
Sundel Robert P.,
Matsui Hiroki,
Fushimi Kiyohide,
Yasunaga Hideo
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23456
Subject(s) - medicine , propensity score matching , kawasaki disease , confidence interval , methylprednisolone , coronary artery disease , relative risk , prednisolone , gastroenterology , artery
Objective Several studies revealed the efficacy of glucocorticoids on prevention of coronary artery lesions ( CAL s) in Kawasaki disease ( KD ) patients. However, impacts of different doses of glucocorticoids on clinical outcomes of KD remain unknown. Methods Using the Japanese Diagnosis Procedure Combination inpatient database, we evaluated KD patients who were treated with normal‐dose (prednisolone 0.5–4.0 mg/kg/day) or high‐dose (methylprednisolone 10–40 mg/kg/day) glucocorticoids. We investigated risks of CAL s and readmission, total hospitalization cost, and length of hospital stay in the acute phase of KD using propensity score matching, stabilized propensity‐score inverse probability of treatment weighting, and instrumental variable methods. Results We identified a total of 3,220 patients with KD who were treated with normal‐dose (n = 2,453) or high‐dose (n = 767) glucocorticoids in addition to intravenous immunoglobulin. One‐to‐one propensity‐matched analyses with 744 pairs demonstrated no significant differences between the normal‐dose and the high‐dose groups in risk of CAL s (risk ratio [ RR ] 0.83, 95% confidence interval [95% CI ] 0.49, 1.40) and risk of readmissions ( RR 0.85, 95% CI 0.65, 1.11). Stabilized propensity‐score inverse probability weighting and instrumental variable analyses showed similar results to the propensity score matching analyses. Conclusion Risks of CAL s and readmissions and total hospitalization costs were similar between the normal‐dose and the high‐dose glucocorticoids groups for patients with KD , whereas total length of hospital stay was shorter in the high‐dose group than that in the normal‐dose group.