Persistence of Nonfebrile Kawasaki Symptoms Tied to Abnormalities

Major Finding: Children with Kawasaki disease who had persistence of only symptoms other than fever after initial IVIG treatment had 18-fold higher odds of developing coronary artery abnormalities relative to their symptom-free peers.

Data Source: A retrospective cohort study of 77 children with Kawasaki disease treated with IVIG and aspirin or the NSAID flurbiprofen.

Disclosures: None was reported.

VANCOUVER, B.C. — Children with Kawasaki disease who have persistence of symptoms other than fever after intravenous immunoglobulin treatment have sharply elevated odds of progressing to coronary artery abnormalities, a retrospective study showed.

In the study, 9% of children had resolution of fever but persistence of lip erythema or bulbar conjunctivitis, and were 18 times more likely to develop coronary artery abnormalities than were their counterparts whose symptoms had resolved. When it comes to identifying children with Kawasaki disease who have resistance to IVIG and need more treatment, clinicians typically watch for a fever that lingers, lead author Dr. Sayaka Fukuda said in an interview. But the importance of persistence of other symptoms is unknown.

Using electronic medical records, Dr. Fukuda and her colleagues retrospectively studied the characteristics and outcomes of children hospitalized with Kawasaki disease who received aspirin (or the NSAID flurbiprofen) plus IVIG as initial treatment.

The children were classified into four groups according to persistence of fever in the 24-36 hours after initial IVIG treatment (yes or no) and persistence of nonfever symptoms 1 month after initial IVIG treatment (yes or no).

Study results reported in a poster session at the meeting were based on 77 children, of whom 8% had persistence of both fever and nonfever symptoms, 9% had persistence of only nonfever symptoms, 18% had persistence of only fever, and 65% had resolution of all their symptoms.

In the group with only nonfever symptoms, these symptoms were lip erythema and bulbar conjunctivitis, according to Dr. Fukuda of the National Center for Child Health and Development in Tokyo.

The only significant difference among the four groups was the duration of hospitalization (P less than .01). The groups were similar with respect to age, sex, season of presentation, presenting symptom, fever duration, and more than a dozen laboratory measures of inflammation and coagulation.

All children with persistent fever had received a second course of IVIG or an alternative treatment, whereas only one of the seven children with persistence of just nonfever symptoms had received further treatment.

Overall, 14% of the children developed coronary artery abnormalities as assessed by ultrasound 1 month after initial treatment. By group, the rate was highest (67%) in those with persistence of both fever and nonfever symptoms, but it was also high (43%) in those with persistence of only nonfever symptoms.

In an adjusted analysis, children with persistence of both fever and nonfever symptoms had 48-fold higher odds of developing coronary artery abnormalities than did the symptom-free group. But children with persistence of only nonfever symptoms had 18-fold higher odds as well. Those with persistence of only fever were not at significantly elevated risk.

Major Finding: Children with Kawasaki disease who had persistence of only symptoms other than fever after initial IVIG treatment had 18-fold higher odds of developing coronary artery abnormalities relative to their symptom-free peers.

Data Source: A retrospective cohort study of 77 children with Kawasaki disease treated with IVIG and aspirin or the NSAID flurbiprofen.

Disclosures: None was reported.

VANCOUVER, B.C. — Children with Kawasaki disease who have persistence of symptoms other than fever after intravenous immunoglobulin treatment have sharply elevated odds of progressing to coronary artery abnormalities, a retrospective study showed.

In the study, 9% of children had resolution of fever but persistence of lip erythema or bulbar conjunctivitis, and were 18 times more likely to develop coronary artery abnormalities than were their counterparts whose symptoms had resolved. When it comes to identifying children with Kawasaki disease who have resistance to IVIG and need more treatment, clinicians typically watch for a fever that lingers, lead author Dr. Sayaka Fukuda said in an interview. But the importance of persistence of other symptoms is unknown.

Using electronic medical records, Dr. Fukuda and her colleagues retrospectively studied the characteristics and outcomes of children hospitalized with Kawasaki disease who received aspirin (or the NSAID flurbiprofen) plus IVIG as initial treatment.

The children were classified into four groups according to persistence of fever in the 24-36 hours after initial IVIG treatment (yes or no) and persistence of nonfever symptoms 1 month after initial IVIG treatment (yes or no).

Study results reported in a poster session at the meeting were based on 77 children, of whom 8% had persistence of both fever and nonfever symptoms, 9% had persistence of only nonfever symptoms, 18% had persistence of only fever, and 65% had resolution of all their symptoms.

In the group with only nonfever symptoms, these symptoms were lip erythema and bulbar conjunctivitis, according to Dr. Fukuda of the National Center for Child Health and Development in Tokyo.

The only significant difference among the four groups was the duration of hospitalization (P less than .01). The groups were similar with respect to age, sex, season of presentation, presenting symptom, fever duration, and more than a dozen laboratory measures of inflammation and coagulation.

All children with persistent fever had received a second course of IVIG or an alternative treatment, whereas only one of the seven children with persistence of just nonfever symptoms had received further treatment.

Overall, 14% of the children developed coronary artery abnormalities as assessed by ultrasound 1 month after initial treatment. By group, the rate was highest (67%) in those with persistence of both fever and nonfever symptoms, but it was also high (43%) in those with persistence of only nonfever symptoms.

In an adjusted analysis, children with persistence of both fever and nonfever symptoms had 48-fold higher odds of developing coronary artery abnormalities than did the symptom-free group. But children with persistence of only nonfever symptoms had 18-fold higher odds as well. Those with persistence of only fever were not at significantly elevated risk.

Major Finding: Children with Kawasaki disease who had persistence of only symptoms other than fever after initial IVIG treatment had 18-fold higher odds of developing coronary artery abnormalities relative to their symptom-free peers.

Data Source: A retrospective cohort study of 77 children with Kawasaki disease treated with IVIG and aspirin or the NSAID flurbiprofen.

Disclosures: None was reported.

VANCOUVER, B.C. — Children with Kawasaki disease who have persistence of symptoms other than fever after intravenous immunoglobulin treatment have sharply elevated odds of progressing to coronary artery abnormalities, a retrospective study showed.

In the study, 9% of children had resolution of fever but persistence of lip erythema or bulbar conjunctivitis, and were 18 times more likely to develop coronary artery abnormalities than were their counterparts whose symptoms had resolved. When it comes to identifying children with Kawasaki disease who have resistance to IVIG and need more treatment, clinicians typically watch for a fever that lingers, lead author Dr. Sayaka Fukuda said in an interview. But the importance of persistence of other symptoms is unknown.

Using electronic medical records, Dr. Fukuda and her colleagues retrospectively studied the characteristics and outcomes of children hospitalized with Kawasaki disease who received aspirin (or the NSAID flurbiprofen) plus IVIG as initial treatment.

The children were classified into four groups according to persistence of fever in the 24-36 hours after initial IVIG treatment (yes or no) and persistence of nonfever symptoms 1 month after initial IVIG treatment (yes or no).

Study results reported in a poster session at the meeting were based on 77 children, of whom 8% had persistence of both fever and nonfever symptoms, 9% had persistence of only nonfever symptoms, 18% had persistence of only fever, and 65% had resolution of all their symptoms.

In the group with only nonfever symptoms, these symptoms were lip erythema and bulbar conjunctivitis, according to Dr. Fukuda of the National Center for Child Health and Development in Tokyo.

The only significant difference among the four groups was the duration of hospitalization (P less than .01). The groups were similar with respect to age, sex, season of presentation, presenting symptom, fever duration, and more than a dozen laboratory measures of inflammation and coagulation.

All children with persistent fever had received a second course of IVIG or an alternative treatment, whereas only one of the seven children with persistence of just nonfever symptoms had received further treatment.

Overall, 14% of the children developed coronary artery abnormalities as assessed by ultrasound 1 month after initial treatment. By group, the rate was highest (67%) in those with persistence of both fever and nonfever symptoms, but it was also high (43%) in those with persistence of only nonfever symptoms.

In an adjusted analysis, children with persistence of both fever and nonfever symptoms had 48-fold higher odds of developing coronary artery abnormalities than did the symptom-free group. But children with persistence of only nonfever symptoms had 18-fold higher odds as well. Those with persistence of only fever were not at significantly elevated risk.