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Primary adjunctive corticosteroid therapy is associated with improved outcomes for patients with Kawasaki disease with coronary artery aneurysms at diagnosis
- Source :
- Archives of Disease in Childhood. 106:247-252
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- ObjectivePatients with Kawasaki disease (KD) with coronary artery enlargement at diagnosis are at the highest risk for persistent coronary artery aneurysms (CAAs) and may benefit from primary adjunctive anti-inflammatory therapy beyond intravenous immunoglobulin (IVIG). We evaluate the effect of primary adjunctive corticosteroid therapy on outcomes in patients with CAA at diagnosis.DesignSingle-centre, retrospective review.PatientsPatients with KD diagnosed within 10 days of fever onset and with baseline CA z-score ≥2.5.InterventionsPrimary treatment with IVIG (n=162) versus IVIG plus corticosteroids (n=48).Main outcome measuresTreatment resistance (persistent fever >36 hours after initial treatment), CAA regression rate.ResultsOf the 92 patients with KD who received corticosteroids at our institution from 2012 to 2019, 48 met the inclusion criteria for primary adjunctive therapy. The corticosteroid group was younger and had larger baseline CAAs compared with historical controls. Demographics and laboratory values were otherwise similar between groups. The corticosteroid group had a less treatment resistance (4% vs 30%, p=0.003) and a greater improvement in C reactive protein. After adjusting for baseline CA z-score, age and baseline bilateral versus unilateral CAA, the corticosteroid group had a higher odds of (OR 2.77 (1.04, 7.42), p=0.042) and a shorter time to CAA regression (HR 1.94 (1.27, 2.96), p=0.002).ConclusionPrimary adjunctive corticosteroid therapy is associated with decreased initial treatment resistance, greater improvement in inflammatory markers and higher likelihood of CAA regression in patients who have CAA at diagnosis. Multi-centre, randomised controlled trials are needed to confirm the benefits of corticosteroids in patients with CAA at diagnosis and to compare corticosteroids with other adjunctive therapies.
- Subjects :
- Male
medicine.medical_specialty
Fever
medicine.drug_class
Coronary Vessel Anomalies
Regression rate
Mucocutaneous Lymph Node Syndrome
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Adrenal Cortex Hormones
Risk Factors
030225 pediatrics
Internal medicine
medicine
Humans
In patient
Treatment resistance
Retrospective Studies
biology
business.industry
C-reactive protein
Coronary Aneurysm
Immunoglobulins, Intravenous
Infant
medicine.disease
C-Reactive Protein
Treatment Outcome
medicine.anatomical_structure
Corticosteroid therapy
Case-Control Studies
Pediatrics, Perinatology and Child Health
biology.protein
Corticosteroid
Drug Therapy, Combination
Female
Kawasaki disease
business
Artery
Subjects
Details
- ISSN :
- 14682044 and 00039888
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- Archives of Disease in Childhood
- Accession number :
- edsair.doi.dedup.....89b42d4fd94a83e210be3aeaeb733b68