Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network - 23/11/23

Doi : 10.1016/j.jpeds.2023.02.001

Hari K. Narayan, MD, MSCE ^1,^{^{∗
Authors contributed equally.}}, Anel Lizcano, PhD, MPH ^2,^{^{∗
Authors contributed equally.}}, Tracy Lam-Hine, DrPH, MBA ^3,⁴, Rolando Ulloa-Gutierrez, MD ^5,⁶, Emelia V. Bainto ¹, Luis M. Garrido-García, MD ⁷, Dora Estripeaut, MD ⁸, Olguita del Aguila, MD ⁹, Virgen Gómez, MD ¹⁰, Enrique Faugier-Fuentes, MD ¹¹, Greta Miño-León, MD ¹², Sandra Beltrán, MD ¹³, Fernanda Cofré, MD ¹⁴, Enrique Chacon-Cruz, MD ¹⁵, Patricia Saltigeral-Simental, MD ¹⁶, Lucila Martínez-Medina, MD ¹⁷, Lourdes Dueñas, MD ¹⁸, Kathia Luciani, MD ¹⁹, Francisco J. Rodríguez-Quiroz, MD ²⁰, Germán Camacho Moreno, MD ²¹, Tamara Viviani, MD ²², Martha I. Alvarez-Olmos, MD, MPH ²³, Heloisa Helena de Sousa Marques, MD ²⁴, Eduardo López-Medina, MD ²⁵, María C. Pirez, MD ²⁶, Adriana H. Tremoulet, MD, MAS ^1,^⁎
and the
Kawasaki Disease REKAMLATINA Network Study Group
Luisa B. Gámez-González, MD, Paola Pérez-Camacho, MD, Jaime Patiño, MD, Daniela Cleves, MD, Lorena Franco, MD, Maria L. Avila-Agüero, MD, Kattia Camacho-Badilla, MD, Alejandra Soriano-Fallas, MD, Susan Li-Chan, MD, Kathia Valverde, MD, Adrián Collia, MD, Alejandro Ellis, MD, Carlos F. Grazioso, MD, Pablo J. Grazioso, MD, Gonzalo Calvimontes, MD, Giannina Izquierdo, MD, Pilar Picart, MD, Mario Melgar, MD, Andrea Salgado, MD, Arturo Borzutzky, MD, Antonio Arbo, MD, Dolores Lovera, MD, Sara Amarilla, MD, Fernando Galeano, MD, Norma Astigarraga, MD, Maria del Carmen Luis-Álvarez, MD, Estefanía Fynn, MD, Elizabeth Assandri, MD, Jacqueline Levy, MD, Elizabeth Castaño, MD, Raúl Esquivel, MD, Ximena Norero, MD, Scarlet Sinisterra, MD, Carlos Daza, MD, Javier Record, MD, Isabel C. Hurtado-Palacios, MD, Antonio Madrid, MD, Angélica Calvache-Burbano, MD, Antonio Fernández, MD, Yasmín Sánchez, MD, Dolores Freire, MD, Marco A. Yamazaki-Nakashimada, MD, Raymundo Rodríguez-Herrera, MD, Diana López-Gallegos, MD, Horacio Márquez-González, MD, Adriana Díaz-Maldonado, MD, Kelly Marquez-Herrera, MD, Neusa Keico Sakita, MD, María Fernanda Badue Pereira, MD, Gabriela Nunes Leal, MD, Pilar Guarnizo, MD, Manuel Huertas-Quiñones, MD, Pio López, MD, Jaime Deseda-Tous, MD, Mónica Pujadas, MD, Guillermo Soza, MD, Carolina Cerda, MD, Issa Lorena López-Medina, MD, Rafael Hernández-Magaña, MD, Saulo Duarte Passos, MD, PhD, Nadina Rubio-Pérez, MD, Fernando García-Rodríguez, MD, Rogelio Martínez-Ramírez, MD, Lorena Rodríguez-Muñoz, MD, Karina Flores-Hernández, MD, Alejandro Díaz-Díaz, MD, Juan G. Mesa-Monsalve, MD, María Mercedes Somarriba, MD, Jesús de Lara-Huerta, MD

¹ University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
² Department of Biology, San Francisco State University, San Francisco, CA
³ School of Public Health, University of California Berkeley, Berkeley, CA
⁴ Department of Epidemiology & Public Health, Stanford University, Stanford, CA
⁵ Servicio de Infectología, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
⁶ Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
⁷ Servicio de Cardiología, Instituto Nacional de Pediatría, Ciudad de México, México
⁸ Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad Panamá, Panamá
⁹ Unidad de Infectología Pediátrica, Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
¹⁰ Servicio de Infectología, Centro Médico Universidad Central del Este Hospital y Hospital Infantil “Dr. Robert Reid Cabral”, Santo Domingo, Dominican Republic
¹¹ Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
¹² Servicio de Infectología, Hospital del Niño “Francisco de Icaza Bustamante”, Guayaquil, Ecuador
¹³ Servicio de Infectología Pediátrica, Clínica Pediátrica Colsanitas, Bogotá, Colombia
¹⁴ Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
¹⁵ Servicio de Infectología Pediátrica, Hospital General de Tijuana, Tijuana, México
¹⁶ Servicio de Infectología, Instituto Nacional de Pediatría y Hospital Infantil Privado, Ciudad de México, México
¹⁷ Servicio de Infectología, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
¹⁸ Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
¹⁹ Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panamá
²⁰ Servicio de Reumatología, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
²¹ Servicio de Infectología, HOMI, Fundación Hospital Pediátrico La Misericordia & Universidad Nacional de Colombia, Bogotá, Colombia
²² Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
²³ Servicio de Infectología Pediátrica, Fundación Cardioinfantil & Universidad El Bosque, Bogotá, Colombia
²⁴ Servicio de Infectología, Hospital Das Clinicas da Faculdade Medicina de la USP, São Paolo, Brazil
²⁵ Centro de Estudios en Infectología Pediátrica, Departamento de Pediatría, Universidad del Valle y Centro Médico Imbanaco, Cali, Colombia, 25 Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
²⁶ Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay

^∗Reprint requests: Adriana H. Tremoulet, MD, MAS, Department of Pediatrics, Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0641, La Jolla, CA 92093Department of PediatricsDepartment of PediatricsUniversity of CaliforniaSan Diego9500 Gilman DriveMC 0641La JollaCA92093

Abstract

Objectives

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).

Study design

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).

Results

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).

Conclusion

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.

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Keywords : coronary artery aneurysm, Kawasaki syndrome, Latin America, pediatric

Abbreviations : AUC, CAA, IVIG, KD, Z-max

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Article 113346- décembre 2023 Retour au numéro

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Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network - 23/11/23

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