Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISE
To detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score. This study included 1757 predicted IVIG responders from Prospective...
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| Veröffentlicht in: | The Journal of pediatrics 2022-01, Vol.240, p.158-163.e4 |
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| container_title | The Journal of pediatrics |
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| creator | Iio, Kazuki Morikawa, Yoshihiko Miyata, Koichi Kaneko, Tetsuji Misawa, Masahiro Yamagishi, Hiroyuki Miura, Masaru |
| description | To detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score.
This study included 1757 predicted IVIG responders from Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a large-scale, multicenter, prospective cohort study of Kawasaki disease in Japan. Predicted IVIG responders were defined as patients with Kawasaki disease with a Kobayashi score of 2.5, age of 2.5 was most strongly associated with CAA development (OR, 7.1; 95% CI, 4.1-12.2; P ≤ .001).
Predicted IVIG responders with CAA risk factors identified in this study may be candidates for future clinical trials of intensified primary IVIG treatment with prednisolone, cyclosporine or infliximab. |
| doi_str_mv | 10.1016/j.jpeds.2021.08.065 |
| format | Article |
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This study included 1757 predicted IVIG responders from Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a large-scale, multicenter, prospective cohort study of Kawasaki disease in Japan. Predicted IVIG responders were defined as patients with Kawasaki disease with a Kobayashi score of <5, a predictive scoring system for IVIG resistance created in Japan. The primary outcome was CAA development at 1 month after disease onset. CAA was defined as a Z score of ≥2.5. Multivariable logistic regression was used to identify the independent risk factors of CAA. The variables for inclusion were identified based on univariate analysis results and previously reported risk factors of CAA.
Among 1632 patients who had complete coronary outcome data, CAA developed in 90 patients (5.5%) at 1 month after disease onset. Multivariable analysis found that a baseline maximum Z score of >2.5, age of <12 months at fever onset, and nonresponsiveness to IVIG were significant, independent risk factors of CAA development at 1 month after disease onset. Among the risk factors, a baseline maximum Z score of >2.5 was most strongly associated with CAA development (OR, 7.1; 95% CI, 4.1-12.2; P ≤ .001).
Predicted IVIG responders with CAA risk factors identified in this study may be candidates for future clinical trials of intensified primary IVIG treatment with prednisolone, cyclosporine or infliximab.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2021.08.065</identifier><identifier>PMID: 34461064</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>baseline Z score ; Child, Preschool ; Coronary Aneurysm - epidemiology ; Coronary Aneurysm - etiology ; Drug Resistance ; Female ; Humans ; Immunoglobulins, Intravenous - administration & dosage ; Immunoglobulins, Intravenous - adverse effects ; Immunoglobulins, Intravenous - therapeutic use ; Immunologic Factors - administration & dosage ; Immunologic Factors - adverse effects ; Infant ; IVIG resistance ; Japan ; Male ; Mucocutaneous Lymph Node Syndrome - drug therapy ; Mucocutaneous Lymph Node Syndrome - epidemiology ; predicted IVIG responder ; Prospective Studies ; Risk Assessment ; Risk Factors</subject><ispartof>The Journal of pediatrics, 2022-01, Vol.240, p.158-163.e4</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-e7bed89f27a7b2f5dbb37de82a0bfe800c9f6c9eddd0262cc0df372eeaa355413</citedby><cites>FETCH-LOGICAL-c359t-e7bed89f27a7b2f5dbb37de82a0bfe800c9f6c9eddd0262cc0df372eeaa355413</cites><orcidid>0000-0002-2049-5309 ; 0000-0001-6041-1731 ; 0000-0002-1437-0374 ; 0000-0003-3314-0571 ; 0000-0002-6430-4957</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022347621008507$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34461064$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iio, Kazuki</creatorcontrib><creatorcontrib>Morikawa, Yoshihiko</creatorcontrib><creatorcontrib>Miyata, Koichi</creatorcontrib><creatorcontrib>Kaneko, Tetsuji</creatorcontrib><creatorcontrib>Misawa, Masahiro</creatorcontrib><creatorcontrib>Yamagishi, Hiroyuki</creatorcontrib><creatorcontrib>Miura, Masaru</creatorcontrib><title>Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISE</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>To detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score.
This study included 1757 predicted IVIG responders from Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a large-scale, multicenter, prospective cohort study of Kawasaki disease in Japan. Predicted IVIG responders were defined as patients with Kawasaki disease with a Kobayashi score of <5, a predictive scoring system for IVIG resistance created in Japan. The primary outcome was CAA development at 1 month after disease onset. CAA was defined as a Z score of ≥2.5. Multivariable logistic regression was used to identify the independent risk factors of CAA. The variables for inclusion were identified based on univariate analysis results and previously reported risk factors of CAA.
Among 1632 patients who had complete coronary outcome data, CAA developed in 90 patients (5.5%) at 1 month after disease onset. Multivariable analysis found that a baseline maximum Z score of >2.5, age of <12 months at fever onset, and nonresponsiveness to IVIG were significant, independent risk factors of CAA development at 1 month after disease onset. Among the risk factors, a baseline maximum Z score of >2.5 was most strongly associated with CAA development (OR, 7.1; 95% CI, 4.1-12.2; P ≤ .001).
Predicted IVIG responders with CAA risk factors identified in this study may be candidates for future clinical trials of intensified primary IVIG treatment with prednisolone, cyclosporine or infliximab.</description><subject>baseline Z score</subject><subject>Child, Preschool</subject><subject>Coronary Aneurysm - epidemiology</subject><subject>Coronary Aneurysm - etiology</subject><subject>Drug Resistance</subject><subject>Female</subject><subject>Humans</subject><subject>Immunoglobulins, Intravenous - administration & dosage</subject><subject>Immunoglobulins, Intravenous - adverse effects</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Immunologic Factors - administration & dosage</subject><subject>Immunologic Factors - adverse effects</subject><subject>Infant</subject><subject>IVIG resistance</subject><subject>Japan</subject><subject>Male</subject><subject>Mucocutaneous Lymph Node Syndrome - drug therapy</subject><subject>Mucocutaneous Lymph Node Syndrome - epidemiology</subject><subject>predicted IVIG responder</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcGO0zAQjRCILQtfgIR85JIwsRMnQeJQlV2oqAQqcLYcewLuJnHxJFv1N_gCvoUvw90uHJFGGmn03puZ95LkeQ5ZDrl8tct2e7SUceB5BnUGsnyQLHJoqlTWQjxMFgCcp6Ko5EXyhGgHAE0B8Di5EEUhc5DFIvm5dXTDrrWZfCDmO7bywY86HNkyTHhqI87hSAMxN7IP-qBJ3zj21hFqQnZw03em2cYf2J1QFFiPU9C3OPqZ2HoY5tF_630795G-RXI06dHg66gbS_fHODmxPnmafv_aLtefr54mjzrdEz6775fJ1-urL6v36ebju_VquUmNKJspxapFWzcdr3TV8q60bSsqizXX0HZYA5imk6ZBay1wyY0B24mKI2otyrLIxWXy8qy7D_7HjDSpwZHBvtcjxuMVL2XV1CCbIkLFGWqCJwrYqX1wQ3RJ5aBOYaidugtDncJQUKsYRmS9uF8wtwPaf5y_7kfAmzMA45u3DoMi4zDaY11AMynr3X8X_AFtjZ-N</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Iio, Kazuki</creator><creator>Morikawa, Yoshihiko</creator><creator>Miyata, Koichi</creator><creator>Kaneko, Tetsuji</creator><creator>Misawa, Masahiro</creator><creator>Yamagishi, Hiroyuki</creator><creator>Miura, Masaru</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2049-5309</orcidid><orcidid>https://orcid.org/0000-0001-6041-1731</orcidid><orcidid>https://orcid.org/0000-0002-1437-0374</orcidid><orcidid>https://orcid.org/0000-0003-3314-0571</orcidid><orcidid>https://orcid.org/0000-0002-6430-4957</orcidid></search><sort><creationdate>202201</creationdate><title>Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISE</title><author>Iio, Kazuki ; Morikawa, Yoshihiko ; Miyata, Koichi ; Kaneko, Tetsuji ; Misawa, Masahiro ; Yamagishi, Hiroyuki ; Miura, Masaru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-e7bed89f27a7b2f5dbb37de82a0bfe800c9f6c9eddd0262cc0df372eeaa355413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>baseline Z score</topic><topic>Child, Preschool</topic><topic>Coronary Aneurysm - epidemiology</topic><topic>Coronary Aneurysm - etiology</topic><topic>Drug Resistance</topic><topic>Female</topic><topic>Humans</topic><topic>Immunoglobulins, Intravenous - administration & dosage</topic><topic>Immunoglobulins, Intravenous - adverse effects</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Immunologic Factors - administration & dosage</topic><topic>Immunologic Factors - adverse effects</topic><topic>Infant</topic><topic>IVIG resistance</topic><topic>Japan</topic><topic>Male</topic><topic>Mucocutaneous Lymph Node Syndrome - drug therapy</topic><topic>Mucocutaneous Lymph Node Syndrome - epidemiology</topic><topic>predicted IVIG responder</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iio, Kazuki</creatorcontrib><creatorcontrib>Morikawa, Yoshihiko</creatorcontrib><creatorcontrib>Miyata, Koichi</creatorcontrib><creatorcontrib>Kaneko, Tetsuji</creatorcontrib><creatorcontrib>Misawa, Masahiro</creatorcontrib><creatorcontrib>Yamagishi, Hiroyuki</creatorcontrib><creatorcontrib>Miura, Masaru</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iio, Kazuki</au><au>Morikawa, Yoshihiko</au><au>Miyata, Koichi</au><au>Kaneko, Tetsuji</au><au>Misawa, Masahiro</au><au>Yamagishi, Hiroyuki</au><au>Miura, Masaru</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISE</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2022-01</date><risdate>2022</risdate><volume>240</volume><spage>158</spage><epage>163.e4</epage><pages>158-163.e4</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>To detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score.
This study included 1757 predicted IVIG responders from Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a large-scale, multicenter, prospective cohort study of Kawasaki disease in Japan. Predicted IVIG responders were defined as patients with Kawasaki disease with a Kobayashi score of <5, a predictive scoring system for IVIG resistance created in Japan. The primary outcome was CAA development at 1 month after disease onset. CAA was defined as a Z score of ≥2.5. Multivariable logistic regression was used to identify the independent risk factors of CAA. The variables for inclusion were identified based on univariate analysis results and previously reported risk factors of CAA.
Among 1632 patients who had complete coronary outcome data, CAA developed in 90 patients (5.5%) at 1 month after disease onset. Multivariable analysis found that a baseline maximum Z score of >2.5, age of <12 months at fever onset, and nonresponsiveness to IVIG were significant, independent risk factors of CAA development at 1 month after disease onset. Among the risk factors, a baseline maximum Z score of >2.5 was most strongly associated with CAA development (OR, 7.1; 95% CI, 4.1-12.2; P ≤ .001).
Predicted IVIG responders with CAA risk factors identified in this study may be candidates for future clinical trials of intensified primary IVIG treatment with prednisolone, cyclosporine or infliximab.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34461064</pmid><doi>10.1016/j.jpeds.2021.08.065</doi><orcidid>https://orcid.org/0000-0002-2049-5309</orcidid><orcidid>https://orcid.org/0000-0001-6041-1731</orcidid><orcidid>https://orcid.org/0000-0002-1437-0374</orcidid><orcidid>https://orcid.org/0000-0003-3314-0571</orcidid><orcidid>https://orcid.org/0000-0002-6430-4957</orcidid></addata></record> |
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| subjects | baseline Z score Child, Preschool Coronary Aneurysm - epidemiology Coronary Aneurysm - etiology Drug Resistance Female Humans Immunoglobulins, Intravenous - administration & dosage Immunoglobulins, Intravenous - adverse effects Immunoglobulins, Intravenous - therapeutic use Immunologic Factors - administration & dosage Immunologic Factors - adverse effects Infant IVIG resistance Japan Male Mucocutaneous Lymph Node Syndrome - drug therapy Mucocutaneous Lymph Node Syndrome - epidemiology predicted IVIG responder Prospective Studies Risk Assessment Risk Factors |
| title | Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISE |
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