Abstract
Background
High-dose aspirin (HDA) is used with intravenous immunoglobulin (IVIg) in Kawasaki disease (KD). Practice regarding HDA varies, and it is unclear whether HDA duration affects the long-term course.
Methods
We retrospectively studied KD patients at our hospital for over 10 years. Patients were categorized as having received HDA for 0, 1–7, or >7 days. Primary outcome was the maximum coronary Z-score at diagnosis and follow-up; secondary outcomes included inflammatory markers.
Results
One hundred and three patients had HDA duration documented, of which 35 patients had coronary artery abnormalities (CAAs) at diagnosis. There was no difference in demographics or inflammatory markers between the HDA groups, and no difference in HDA duration between patients with or without CAAs. Seventeen patients received no HDA; they had longer illness and defervescence duration before diagnosis, and were less likely to receive IVIg. For CAAs, multivariate regression revealed that HDA duration did not predict the coronary Z-score at 9–15 months. Higher Z-score at diagnosis was associated with higher Z-score at 9–15 months.
Conclusion
The only factor associated with coronary Z-score at 9–15 months was the Z-score at diagnosis. At our institution, longer illness and defervescence duration and the lack of IVIg administration were associated with not administering HDA. HDA duration did not affect the clinically relevant outcomes, particularly CAA persistence.
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References
Kawasaki T . Infantile acute febrile mucocutaneous lymph node syndrome with specific desquamation of the fingers and toes. Clinical observation of 50 cases. Jpn J Allerg 1967: 178–222.
Newburger JW, Takahashi M, Burns JC . Kawasaki disease. J Am Coll Cardiol 2016;67:1738–1749.
Newburger JW, Takahashi M, Burns JC et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;315 (6): 341–347.
Melish ME, Hicks RV, Reddy V . Kawasaki syndrome: an update. Hosp Pract (Hosp Ed) 1982;17:99–106.
Furusho K, Kamiya T, Nakano H et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet 1984;2:1055–1058.
Newburger JW, Takahashi M, Beiser AS et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324:1633–1639.
Dajani AS, Taubert KA, Gerber MA et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776–1780.
Asai T, Kiguciii H, Nagai Y et al. Analysis of cardiac involvement in 29 cases with MCLS. Jpn J Pediatr 1973;26:824–836.
Kato H, Koike S, Yokoyama T . Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 1979;63:175–179.
Yokoyama T, Kato H, Ichinose E . Aspirin treatment and platelet function in Kawasaki disease. Kurume Med J 1980;27:57–61.
Jacobs JC . Salicylate treatment of epidemic Kawasaki disease in New York City. Ther Drug Monit 1979;1:123–130.
Koren G, MacLeod SM . Difficulty in achieving therapeutic serum concentrations of salicylate in Kawasaki disease. J Pediatr 1984;105:991–995.
Koren G, Rose V, Lavi S et al. Probable efficacy of high-dose salicylates in reducingcoronary involvement in Kawasaki disease. JAMA 1985;254:767–769.
Melish ME, Takahashi M, Shulman ST et al. Comparison of low dose aspirin vs. high dose aspirin as an adjunct to intravenous gamma globulin in the treatment of Kawasaki syndrome [abstract]. Pediatr Res 1992;31:170A.
Durongpisitkul K, Gururaj VJ, Park JM et al. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995;96:1057–1061.
Terai M, Shulman ST . Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997;131:888–893.
Saulsbury FT . Comparison of high-dose and low-dose aspirin plus intravenous immunoglobulin in the treatment of Kawasaki syndrome. Clin Pediatr (Phila) 2002;41:597–601.
Shulman ST (Ed.). Management of Kawasaki syndrome: a consensus statement prepared by North American participants of the Third International Kawasaki Disease Symposium, Tokyo, Japan, December, 1988. Pediatr Infect Dis J 1989;8:663–667.
Newburger JW, Takahashi M, Gerber MA et al. Council on Cardiovascular Disease in the Young; American Heart Association; American Academy of Pediatrics. 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;110:2747–2771.
McCrindle BW, Rowley AH, Newburger JW et al. American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017;135:e927–e999.
Baumer JH, Love SJ, Gupta A et al. Salicylate for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2006;4:CD004175.
Colan SD . Normal echocardiographic values for cardiovascular structures In: Lai WW, Cohen MS, Geva T, Mertens L eds. Echocardiography in Pediatric and Congenital Heart Disease, Appendix 1 West Sussex, UK: Wiley-Blackwell, 2009: 772–773.
Bland JM, Altman DG . Multiple significance tests: the Bonferroni method. BMJ 1995;310:170.
McCrindle BW, Li JS, Minich LL Pediatric Heart Network Investigatorset al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007;116:174–179.
Friedman KG, Gauvreau K, Hamaoka-Okamoto A et al. Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US population. J Am Heart Assoc 2016;5:e003289.
Kuo HC, Lo MH, Hsieh KS et al. High-dose aspirin is associated with anemia and does not confer benefit to disease outcomes in Kawasaki disease. PLoS ONE 2015;10:e0144603.
Dallaire F, Fortier-Morissette Z, Blais S et al. Aspirin dose and prevention of coronary abnormalities in Kawasaki disease. Pediatrics 2017;139:e20170098.
Dhanrajani A, Chan M, Pau S et al. Aspirin dose in Kawasaki disease—the ongoing battle. Arthritis Care Res; advance online publication, 29 December 2017; https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.23504.
Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery Committee for Development of Guidelines for Medical Treatment of Acute Kawasaki Disease. Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version). Pediatr Int 2014;56:135–158.
Lee JH, Hung HY, Huang FY . Kawasaki disease with Reye syndrome: report of onecase. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1992;33:67–71.
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We acknowledge Michael Muradian for assisting with initial data collection.
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Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114.
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Migally, K., Braunlin, E., Zhang, L. et al. Duration of high-dose aspirin therapy does not affect long-term coronary artery outcomes in Kawasaki disease. Pediatr Res 83, 1136–1145 (2018). https://doi.org/10.1038/pr.2018.44
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DOI: https://doi.org/10.1038/pr.2018.44
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