Clinical features of Kawasaki disease and analysis of risk factors for coronary damage

Xijia Xu; Fuyong Jiao; Fan Yang; Xinxin Xue; Yufen Hui; Hongping Zhong; Xijia Xu; Fuyong Jiao; Fan Yang; Xinxin Xue; Yufen Hui; Hongping Zhong

doi:10.3934/medsci.2025014

AIMS Medical Science

2025, Volume 12, Issue 2: 223-235. doi: 10.3934/medsci.2025014

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Research article

Clinical features of Kawasaki disease and analysis of risk factors for coronary damage

1.
Department of Paediatrics, Yan'an University Affiliated Hospital, Yan'an-716000, China
2.
Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an Jiaotong Univeristy, Xi'an-710000, Shaanxi Province, China
3.
Department of Laboratory, Affiliated Hospital of Yan'an University, Yan'an-716000, China

Received: 29 March 2025 Revised: 13 May 2025 Accepted: 22 May 2025 Published: 12 June 2025

Objective
To investigate the clinical characteristics and risk factors for coronary artery lesion (CAL) in Kawasaki disease (KD) through a comprehensive analysis of 418 pediatric cases, thereby enhancing the diagnostic and therapeutic approaches for this condition.
Methods
We conducted a retrospective analysis of 418 children diagnosed with KD and hospitalized between January 2017 and January 2024. Data on clinical manifestations, laboratory findings, echocardiography results, and treatment outcomes were systematically reviewed.
Results
Among the 418 KD patients, the male-to-female ratio was 2.07:1 (276 males, 66.03%; 142 females, 33.97%), with 84.92% (355/418) under 5 years of age. The cohort included 292 cases (69.86%) of typical KD and 126 cases (30.14%) of incomplete KD. Coronary artery lesions were identified in 11.72% (49/418) of patients, with significantly higher incidence in the incomplete KD group [23.02% (29/126)] compared to the typical KD group [6.85% (20/292); χ² = 16.00, P < 0.001]. Subgroup analysis revealed that infants < 1 year old had a higher CAL rate [24.72% (22/89)] than 1–5-year-olds [9.40% (25/266); χ² = 11.95, P < 0.001]. Regarding treatment timing, the CAL incidence was significantly lower in patients receiving intravenous IVIG within 7 days of fever onset [6.74% (18/267)] compared to those treated at 7–10 days [20.53% (31/151); χ² = 16.53, P < 0.001].
Conclusions
Kawasaki disease primarily affects infants, with children under 1 year at higher risk for coronary artery lesions. Incomplete cases often present with atypical symptoms, requiring prompt diagnosis through imaging and lab tests. Early Intravenous immunoglobulin (IVIG) (2 g/kg) combined with aspirin within 7 days of onset significantly reduces coronary complications (6.74% vs. 20.53% with delayed treatment). Glucocorticoids are reserved for severe or IVIG-resistant cases. Immediate treatment initiation, regular echocardiography monitoring (using Z-score), and anticoagulation for high-risk patients are essential. Long-term follow-up is mandatory, with lifetime management for coronary abnormalities. The key strategy involves early recognition, standardized treatment within 10 days (optimally 7 days), and systematic follow-up to improve outcomes.
- Kawasaki disease,
- coronary artery lesions,
- clinical features,
- incomplete Kawasaki disease
Citation: Xijia Xu, Fuyong Jiao, Fan Yang, Xinxin Xue, Yufen Hui, Hongping Zhong. Clinical features of Kawasaki disease and analysis of risk factors for coronary damage[J]. AIMS Medical Science, 2025, 12(2): 223-235. doi: 10.3934/medsci.2025014

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Abstract

Objective

To investigate the clinical characteristics and risk factors for coronary artery lesion (CAL) in Kawasaki disease (KD) through a comprehensive analysis of 418 pediatric cases, thereby enhancing the diagnostic and therapeutic approaches for this condition.

Methods

We conducted a retrospective analysis of 418 children diagnosed with KD and hospitalized between January 2017 and January 2024. Data on clinical manifestations, laboratory findings, echocardiography results, and treatment outcomes were systematically reviewed.

Results

Among the 418 KD patients, the male-to-female ratio was 2.07:1 (276 males, 66.03%; 142 females, 33.97%), with 84.92% (355/418) under 5 years of age. The cohort included 292 cases (69.86%) of typical KD and 126 cases (30.14%) of incomplete KD. Coronary artery lesions were identified in 11.72% (49/418) of patients, with significantly higher incidence in the incomplete KD group [23.02% (29/126)] compared to the typical KD group [6.85% (20/292); χ² = 16.00, P < 0.001]. Subgroup analysis revealed that infants < 1 year old had a higher CAL rate [24.72% (22/89)] than 1–5-year-olds [9.40% (25/266); χ² = 11.95, P < 0.001]. Regarding treatment timing, the CAL incidence was significantly lower in patients receiving intravenous IVIG within 7 days of fever onset [6.74% (18/267)] compared to those treated at 7–10 days [20.53% (31/151); χ² = 16.53, P < 0.001].

Conclusions

Kawasaki disease primarily affects infants, with children under 1 year at higher risk for coronary artery lesions. Incomplete cases often present with atypical symptoms, requiring prompt diagnosis through imaging and lab tests. Early Intravenous immunoglobulin (IVIG) (2 g/kg) combined with aspirin within 7 days of onset significantly reduces coronary complications (6.74% vs. 20.53% with delayed treatment). Glucocorticoids are reserved for severe or IVIG-resistant cases. Immediate treatment initiation, regular echocardiography monitoring (using Z-score), and anticoagulation for high-risk patients are essential. Long-term follow-up is mandatory, with lifetime management for coronary abnormalities. The key strategy involves early recognition, standardized treatment within 10 days (optimally 7 days), and systematic follow-up to improve outcomes.

Acknowledgments

This manuscript is funded by the project of Shaanxi Provincial Science and Technology Department, “Research on the predictive indicators of Kawasaki disease gammaglobulin resistance and coronary artery lesions”; 2024SF-YBXM-307.

Conflict of interest

The authors declare no conflict of interest.

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