Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network
Hari K. Narayan, Anel Lizcano, Tracy Lam-Hine, Rolando Ulloa‐Gutiérrez, Emelia Bainto, Luis M Garrido‐García, Dora Estripeaut, Olguita del Águila, Virgen Gómez, Enrique Faugier Fuentes, Greta Miño-León, Sandra Beltrán, Fernanda Cofré, Enrique Chacón‐Cruz, Patricia Saltigeral‐Simental, Lucila Martínez‐Medina, Lourdes Dueñas, Kathia Luciani, Francisco J. Rodríguez-Quiroz, Germán Camacho‐Moreno, Tamara Viviani, Martha I. Álvarez-Olmos, Heloísa Helena de Sousa Marques, Eduardo López‐Medina, Catalina Pírez, Adriana H. Tremoulet, Luisa Berenise Gámez‐González, Paola Pérez-Camacho, Jaime Patiño, Daniela Cleves, Lorena Franco, María L. Ávila-Agüero, Kattia Camacho-Badilla, Alejandra Soriano‐Fallas, Susan Li-Chan, Kathia Valverde, Adrián Collia, Alejandro Ellis, Carlos Grazioso, P. Grazioso, Gonzalo Calvimontes, Giannina Izquierdo, Pilar Picart, Mario Melgar, Andrea Salgado, Arturo Borzutzky, Antonio Arbo, Dolores Lovera, Sara Amarilla, F Galeano, Norma Astigarraga, Maria del Carmen Luis-Álvarez, Estefanía Fynn, Elizabeth Assandri, Jacqueline Levy, Elizabeth Castaño, R. Esquivel–Sirvent, Ximena Norero, Scarlet Sinisterra, Carlos Daza, Javier Record, Isabel C. Hurtado-Palacios, Antonio Hernández‐Madrid, Angélica Calvache-Burbano, Antonio Fernández, Yasmín Sánchez, Dolores Freire, Marco Antonio Yamazaki‐Nakashimada, Raymundo Rodríguez-Herrera, Diana López-Gallegos, Horacio Márquez-González, Adriana Díaz-Maldonado, Kelly Marquez-Herrera, Neusa Keico Sakita, Maria Fernanda Bádue Pereira, Gabriela Nunes Leal, Pilar Guarnizo, Manuel Huertas Quiñones, Pío López, Jaime Deseda-Tous, Mónica Pujadas, Guillermo Soza, Carolina Cerda, Issa Lorena López-Medina, Rafael Hernández-Magaña, Saulo Duarte Passos, Nadina Rubio‐Pérez, Fernando García Rodríguez, Rogelio Martínez-Ramírez, Lorena Rodríguez-Muñoz, Karina Flores-Hernández, Alejandro Díaz, Juan Gonzalo Mesa-Monsalve, María Mercedes Somarriba, Jesús de Lara-Huerta
Abstract
ObjectivesTo describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA).Study designAn observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG).ResultsOf 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88).ConclusionFrom our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD. To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.