Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age

Introduction: The clinical manifestations and risk factors for developing coronary artery abnormalities (CAA) in Kawasaki disease (KD) might differ depending on age. Materials and methods: From January 2001 to July 2007, 161 patients with an age younger than 1 year (younger group) and 60 patients with an age older than 5 years (older group) were diagnosed with KD at the Korea University Medical Center. Their medical records were reviewed retrospectively and the two groups were compared in terms of a number of variables commonly associated with the development of CAA, including clinical manifestations and laboratory findings. Results: While the overall incidence of KD-associated CAA in our hospital was 6.7%, CAA developed in 20 (12.4%) of the younger group and ten (16.7%) of the older group, respectively. The CAA (+) cases of the younger group had a longer duration of total fever (9.1∈±∈3.3 vs 6.3∈±∈1.9 days, p∈=∈0.002) and showed fewer diagnostic symptoms (3.0∈±∈1.2 vs 4.3∈±∈1.1, p∈<∈0.001) than the CAA (-) cases. The CAA (+) cases of the older group had a longer duration of total fever (14.1∈±∈10.4 vs 6.5∈±∈1.9 days, p∈=∈0.045), especially with respect to post-intravenous gamma globulin (IVGG) fever (7.9∈±∈9.6 vs 1.1∈±∈0.8 days, p∈=∈0.052), and had higher total white blood cell counts, erythrocyte sedimentation rates, C-reactive protein levels, total bilirubin levels, and Harada scores and lower serum albumin and sodium levels than the CAA (-) cases. Multivariable logistic regression analysis revealed that the factors that were associated significantly with the development of CAA were the number of total symptoms (OR∈=∈0.494, 95% confidence interval (CI)∈=∈0.281-0.871, p∈=∈0.015) in the younger group and the duration of post-IVGG fever (OR∈=∈1.958, 95% CI∈=∈1.098-3.492, p∈=∈0.023) and the Harada score (OR∈=∈3.455, 95% CI∈=∈1.012-11.796, p∈=∈0.048) in the older group. Conclusion: Incomplete clinical manifestations in the younger group and IVGG nonresponsiveness in the older group are associated with the development of KD-associated CAA. These age-specific characteristics could aid the customization of the diagnostic and therapeutic strategies of KD, thereby helping to improve the outcome of this disease.