University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA.
Department of Biology, San Francisco State University, San Francisco, CA.
J Pediatr. 2023 Dec;263:113346. doi: 10.1016/j.jpeds.2023.02.001. Epub 2023 Feb 11.
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).
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).
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).
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.
描述拉丁美洲川崎病（KD）的临床特征、治疗方法和转归，并评估冠状动脉瘤（CAA）的早期预后指标。
本研究为观察性 KD 登记研究，2009 年 1 月 1 日至 2013 年 12 月 31 日在拉丁美洲 19 个国家的 64 家儿科中心进行回顾性分析，2014 年 6 月 1 日至 2017 年 5 月 31 日进行前瞻性分析。收集人口统计学、初始临床和实验室数据。采用包含临床因素和初始表现时（静脉用免疫球蛋白[IVIG]前 10 天至后 5 天）最大冠状动脉 z 评分的 Logistic 回归来建立随访期间（IVIG 后>5 天）CAA 的预后模型。
在 1853 例 KD 患者中，延迟就诊（发热后>10 天）占 16%，不完全 KD 占 25%，IVIG 耐药占 11%。在 671 例有随访期间冠状动脉 z 评分报告的患者中（中位数：79 天；IQR：36，186），21%有 CAA，其中 4%为巨大动脉瘤。仅使用初始表现时最大冠状动脉 z 评分≥2.5 的简单预后模型预测随访期间 CAA 的效果最佳（曲线下面积：0.84；95%CI：0.80，0.88）。
在我们的拉丁美洲人群中，初始表现时冠状动脉 z 评分≥2.5 是预测随访期间 CAA 的最重要的预后因素。这些结果突出了在 KD 初始表现时早期行超声心动图检查的重要性。
