Acute Phase Complications of Older Children with Kawasaki Disease

Abstract

Background: Older children with Kawasaki disease (KD) have a risk for acute phase complications including coronary artery lesions (CALs).Objective: To clarify the frequency and outcomes of acute phase complications in older children who received an initial single intravenous immunoglobulin (IVIG) therapywith delayed use of aspirin. Subjects and Methods: This retrospective study included data from 216 consecutive patients who underwent initial single IVIG therapy at 2 g/kg with DUA. The data were divided into a group for cases aged 5 years or older (older group, n = 34) and another group for cases aged <5 years (younger group, n = 182). Statistical analyses were performed using Chi-square, Fishers exact, and MannWhitney U tests as appropriate. Results: Six of 34 (17.6%) older group patients were associated with complications (2 with CAL and 4 with non-cardiac complications required treatment). The non-cardiac complications included arthritis, transient blindness, and atlantoaxial rotatory fixation. All of these non-cardiac complications were recovered after treatment. The rate of CAL in older group patients was similar to that in younger group patients (5.9% vs. 1.6%, P = 0.177). However, the rate of non-cardiac complications in the former was significantly higher than that of the latter (11.8% vs. 0.0%, P < 0.001). Conclusion: Whereas the older children who underwent initial single IVIG therapy at 2 g/kg with DUA have the higher risk for non-cardiac complications compared to the younger patients, the rate of CAL was similar between the older and younger children.