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Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method
Author(s) -
Satoh Kaoru,
Wakejima Yoko,
Gau Maki,
Kiguchi Tomoyuki,
Matsuda Nozomi,
Takasawa Reiko,
Takasawa Kei,
Nishioka Masato,
Shimohira Masayuki
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13223
Subject(s) - medicine , kawasaki disease , incidence (geometry) , artery , gastroenterology , coronary artery disease , pediatrics , urinary system , natriuretic peptide , cardiology , heart failure , physics , optics
Aim To examine clinical characteristics of Kawasaki disease ( KD ) in infants younger than 3 months of age and to develop a method for detecting KD in febrile infants. Method In a case‐control study, we retrospectively collected clinical and laboratory data from 24 KD infants younger than 3 months of age out of 410 KD patients. We then compared younger infants with both older patients and febrile infants with respiratory syncytial virus ( RSV ) infection and urinary tract infections ( UTI ). Results The frequency of incomplete KD was higher in the younger group than in the control group (79% vs . 36%, P < 0.0001). Furthermore, before treatment, the incidence of coronary artery lesions ( CAL ) was significantly higher in the younger group (29% vs . 3.9%, P = 0.0001), resulting in a higher incidence of coronary artery sequelae (21% vs . 3.4%, P = 0.0023). Our results revealed that the serum N‐terminal prohormone of brain natriuretic peptide ( NT ‐pro BNP ) level of KD patients was higher than that of RSV and UTI patients (3110 ± 2076 vs . 698 ± 436, P = 0.0001; and 971 ± 589 pg/ mL , P = 0.0002, respectively). Thus, NT ‐pro BNP might be suitable as a diagnostic marker of KD in young infants ( P = 0.0005, criterion values: 1555 pg/ mL [sensitivity: 80%, specificity: 85%]). Conclusion Kawasaki disease infants younger than 3 months of age appear to be at higher risk for incomplete KD and early‐onset CAL prior to the appearance of coronary artery sequelae. We suggest performing an echocardiogram and evaluating NT ‐pro BNP in young infants with fever that has lasted longer than 2 days, regardless of the presence or absence of manifestations associated with KD .