Kawasaki Disease in the Pre- and Post-COVID-19 Era: Shifts in Patterns and Outcomes from a Multi-Center Study

Purpose Kawasaki disease (KD) is an acute vasculitis of childhood, with potential complications such as coronary artery aneurysms (CAA). The COVID-19 pandemic introduced challenges in KD diagnosis and management due to its overlap with multisystem inflammatory syndrome in children (MIS-C). This study aims to compare the clinical presentation, laboratory findings, treatment approaches, and outcomes of KD before and after the COVID-19 pandemic across four centers in the United Arab Emirates (UAE). Methods This retrospective study analyzed pediatric KD cases (classified per the American Heart Association “AHA” criteria) from four tertiary hospitals in the UAE. Patients were categorized into Group 1 (pre-COVID-19: January 2017-January 2020) and Group 2 (post-COVID-19: February 2020-January 2023). Patients not meeting the AHA criteria and those with MIS-C were excluded. Data collection included demographics, clinical and laboratory features, echocardiograms, with coronary artery abnormalities assessed per AHA guidelines. Results Among 138 included patients (67 in Group 1, 71 in Group 2), incomplete KD was significantly more common post-COVID-19 (45% vs. 25%, p  = 0.020). Compared to Group 1, Group 2 had higher use of steroids (40.8% vs 12.5%, p  = < 0.001) and biologics (8% vs 1.5%, p  = 0.502). Although not statistically significant, CAAs were more frequent in Group 2 (21% vs 10%, p  = 0.139), with trends toward increased giant CAAs. Conclusions our study highlights shifts in the patterns of KD in the post-COVID-19 era. We observed a higher prevalence of incomplete KD cases over the three years following the pandemic, along with an increasing trend in CAAs and giant CAAs.