Risk factors associated with persistent coronary artery lesions in children with Kawasaki Disease in an Italian cohort

Purpose: Kawasaki disease (KD) can be complicated, mainly during the acute stage, by coronary artery lesions (CALs); their persistence, after the subacute stage, increases cardiovascular morbidity and life-threatening events lifelong. While several scores, based on Asians and Americans, have been proposed to predict the risk of CALs or non-response, less efforts have been aimed to identify risk factors associated with the persistence of CALs (pCALs). Our study aimed, firstly, to identify the risk factors for pCALs in Italian patients and, secondly, to assess the validity of an existing risk score, previously applied to a North-Americans. Methods: Data of KD patients from 11 Italian sites were registered into a centralized RedCap database. pCALs were defined as the persistence of CALs 8 weeks after the diagnosis. Clinical, demographic and laboratory features of patients with and without pCALs were analyzed and compared. Multiple logistic regression was used to identify independent risk factors for pCALs. A ROC analysis was conducted to assess the performance and reliability of the existing risk score model to predict the persistence of CALs. Results: 517 children were enrolled (Caucasian 87.4%) of which 52 developed pCALs. pCALs were more prevalent in males (12.03% p=0.06), Asian ethnicity (26.9%, p: 0.026), younger patients (61.5%, p: 0.05), incomplete clinical presentation (p=0.03), and associated with pathological features at abdominal ultrasound (p=0.04). Children with pCALs had higher WBC and CRP but lower Hb. Male gender (12.03% p=0.06), age younger than 6 months (61.5%, p: 0.05), Asian ethnicity (26.9%, p: 0.026), fever longer than 10 days, incomplete presentation(p=0.03), CRP >13 mg>dl were independent risk factors for pCALs. Children who developed pCALs, compared to those with acute CALs, were younger, mostly IVIG non-responders (34.6%, 18/52 versus 29.6%, 153/517; p<0.001) and late-treated. Additionally, Son's risk score demonstrated high predictive value in identifying children at greater risk for pCALs. Conclusions: Male gender, younger age, incomplete clinical presentation, Asian ethnicity, and elevated CRP levels are independent risk factors for pCALs in our Italian cohort. Notably, the risk score developed by Son et al. demonstrated its potential utility in identifying children who may benefit from closer follow-up and early adjunctive therapy to limit coronary damage and related morbidity in a predominantly Caucasian population.