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Background <p>Kawasaki disease (KD) is an acute vasculitic disease of unknown etiology, which mostly occurs in infants and young children. Coronary artery lesions (CAL) are an important complication, mainly in patients who are not treated with intravenous immunoglobulin (IVIG) in time or who are resistant to IVIG. Several previous studies have revealed the correlation of certain biochemical markers with coronary artery lesions.</p> Aims <p>Our study is mainly aimed at finding the factors that predict the occurrence of coronary artery lesions and affect the response to IVIG treatment so as to facilitate early detection and timely intervention.</p> Methods <p>We collected clinical data and laboratory indicators of 480 patients with KD in the pediatric ward from 2018 to 2023 and conducted a retrospective analysis. We grouped 258 patients with complete KD and 222 patients with incomplete KD based on their coronary artery status and IVIG treatment response. We used logistic regression analysis to identify the factors associated with coronary artery lesions and IVIG resistance, and we completed the survival curve analysis.</p> Results <p>Patients with incomplete KD lacked characteristic clinical manifestations, and the incidence of CAL was higher than that of patients with complete KD (52.06% vs. 47.94%, <i>P</i> &lt; 0.001). The age of the patients with CAL was relatively younger, and the fever duration was longer. Compared with the group without CAL, the white blood cell counts, neutrophil ratio, and ESR were lower, and the lymphocyte ratio was higher. Among them, age &gt; 1 year old, with rash and fingertip hard swelling, white blood cell counts &gt; 13.35 × 109/L, and ESR &gt; 33.5&#xa0;mm/h were protective factors for CAL (OR &lt; 1). IVIG-resistant patients had longer fever duration, higher rates of coronary aneurysms, and lower serum sodium levels than non-resistant patients(133.80(132.00-136.40)vs136.63(134.70-138.50), <i>P</i> &lt; 0.001). KD patients with coronary aneurysms, corticosteroid therapy, or with the fever duration &gt; 6 days have a higher risk for IVIG resistance(OR &gt; 1), while serum sodium &gt;135.35mmol/L reduces the risk of IVIG resistance(OR &lt; 1).</p> Conclusion <p>In children with KD, age &gt; 1 years old, with rash and fingertip swelling, white blood cell counts &gt; 13.35 × 109/L, and ESR &gt; 33.5&#xa0;mm/h, CAL is less likely. IVIG resistance was mostly due to the longer duration of fever (&gt; 6 days), lower serum sodium level (&lt; 135.35 mmol/L), and the presence of coronary aneurysm.</p>

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Analysis of risk factors of coronary artery lesions in Kawasaki disease and study of IVIG treatment response

  • 期刊论文

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  • 发表日期：

    2026年1月22日

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  • Zhuoyue Li,
  • Wenjuan Guo,
  • Rong Wang,
  • Kun Zhang

摘要

Background

Kawasaki disease (KD) is an acute vasculitic disease of unknown etiology, which mostly occurs in infants and young children. Coronary artery lesions (CAL) are an important complication, mainly in patients who are not treated with intravenous immunoglobulin (IVIG) in time or who are resistant to IVIG. Several previous studies have revealed the correlation of certain biochemical markers with coronary artery lesions.

Aims

Our study is mainly aimed at finding the factors that predict the occurrence of coronary artery lesions and affect the response to IVIG treatment so as to facilitate early detection and timely intervention.

Methods

We collected clinical data and laboratory indicators of 480 patients with KD in the pediatric ward from 2018 to 2023 and conducted a retrospective analysis. We grouped 258 patients with complete KD and 222 patients with incomplete KD based on their coronary artery status and IVIG treatment response. We used logistic regression analysis to identify the factors associated with coronary artery lesions and IVIG resistance, and we completed the survival curve analysis.

Results

Patients with incomplete KD lacked characteristic clinical manifestations, and the incidence of CAL was higher than that of patients with complete KD (52.06% vs. 47.94%, P < 0.001). The age of the patients with CAL was relatively younger, and the fever duration was longer. Compared with the group without CAL, the white blood cell counts, neutrophil ratio, and ESR were lower, and the lymphocyte ratio was higher. Among them, age > 1 year old, with rash and fingertip hard swelling, white blood cell counts > 13.35 × 109/L, and ESR > 33.5 mm/h were protective factors for CAL (OR < 1). IVIG-resistant patients had longer fever duration, higher rates of coronary aneurysms, and lower serum sodium levels than non-resistant patients(133.80(132.00-136.40)vs136.63(134.70-138.50), P < 0.001). KD patients with coronary aneurysms, corticosteroid therapy, or with the fever duration > 6 days have a higher risk for IVIG resistance(OR > 1), while serum sodium >135.35mmol/L reduces the risk of IVIG resistance(OR < 1).

Conclusion

In children with KD, age > 1 years old, with rash and fingertip swelling, white blood cell counts > 13.35 × 109/L, and ESR > 33.5 mm/h, CAL is less likely. IVIG resistance was mostly due to the longer duration of fever (> 6 days), lower serum sodium level (< 135.35 mmol/L), and the presence of coronary aneurysm.