CARDIOVASCULAR SYSTEM LESIONS, RISK FACTORS AND PREDICTORS FOR ADVERSE OUTCOMES IN CHILDREN WITH KAWASAKI DISEASE

Abstract

Purpose of the research was to study the structure of the cardiovascular system (CVS) lesions, risk factors and predictors for adverse outcomes in children with Kawasaki disease (KD). Materials and methods used: a single-center retrospective cohort study of 188 patients (126 boys/62 girls) aged 2 months to 11 years old with KD in 2014-2019. Depending on the outcome of the disease, the two groups of patients were identified: those with recovery (171/188, 91%), and with unfavorable outcomes (17/188, 9%) in the form of persistent coronary artery aneurysms (CAA) in 12 (6.4%) cases and death in 5 (2.7%) cases. Authors used the clinical-anamnestic method, clinical and biochemical blood tests and coagulogram. The diagnosis of CVS changes was based on the results of echocardiography, magnetic resonance angiography, coronary angiography and ultrasound of non-coronary vessels. The levels of N-terminal fragment of B-type brain natriuretic peptide (NT-proBNP) and atrial natriuretic peptide precursor (proANP) were determined. Results: CVS lesions in the acute period of KD were detected in 92 (48.9%) patients. Non-coronary changes in the cardiovascular system, represented by myocarditis (25%), pericarditis (9.6%), transient mitral valve insufficiency (26.1%) with valvulitis (4.3%) were determined in the acute and subacute periods of KD. Damage to the coronary arteries (CA) in the acute period, according to echocardiography, was detected in 61 (32.4%) children, of which: coronaritis - in 43 (22.8%), transient ectasia - in 9 (4.7% ), CAA of various sizes - in 49 (26.1%). Predictors of unfavorable KD outcomes are the presence of coronary (p=0.000) and non-coronary changes (p=0.001) in the cardiovascular system during the acute period of the disease, blood clots of any location (64.7% v. 3.5%, p=0.000). Based on the results of univariate logistic regression analysis, significant threshold levels of natriuretic peptides were established to determine the risk of developing adverse KD outcomes: an increase in NT-proBNP in the acute period of KD more than 984 pg/ml with 79% sensitivity, 84.8% specificity, 82.9% overall predictive value; an increase in proANP greater than 1.015 nmol/l with 87.5% a sensitivity, 75.8% specificity and 78.0% overall predictive value. Conclusion: risk factors and predictors for the unfavorable KD outcomes have been identified as follows: the appearance in the acute period of CAA of medium and especially giant sizes, pericarditis, myocarditis, damage to the valvular apparatus, thrombosis of the coronary artery and cardiac cavities, high levels of proANP, NT-proBNP, which can be used as a diagnostic tool in KD with poor outcomes.