Gastrointestinal abnormalities as predictors of cardiovascular involvement in Kawasaki disease: a 5-year retrospective study

Kawasaki disease (KD) is an acute, self-limited vasculitis in children that can lead to significant cardiovascular complications. Gastrointestinal manifestations and related laboratory abnormalities are common in KD, but their association with cardiovascular involvement remains incompletely understood. This study aimed to evaluate the relationship between gastrointestinal-related laboratory and imaging findings and echocardiographic outcomes in pediatric KD. We conducted a retrospective study of 258 children with KD admitted from 2019 to 2024. Demographic, clinical, laboratory, and imaging data, including echocardiography and abdominal ultrasonography, were collected. Univariate and multivariate logistic regression analyses were performed to identify cardiovascular involvement, including coronary artery aneurysm, dilatation, brightness, and valvular abnormalities. Among 258 patients (mean age 3.53 ± 2.69 years; 67.4% male), abnormal echocardiographic findings were observed in 70.7%. Coronary artery aneurysms and dilatation occurred in 9.8% and 9.4%, respectively. Abnormal abdominal sonography was detected in 21.3%. Multivariate analysis identified male sex, anemia, hypoalbuminemia, elevated alkaline phosphatase, elevated C-reactive protein, and prolonged partial thromboplastin time as independent associated factors of cardiovascular involvement in KD patients. Gastrointestinal-related laboratory abnormalities are significantly associated with cardiovascular involvement in children with KD. Early recognition of high-risk patients, particularly males with anemia, hypoalbuminemia, elevated inflammatory markers, and abnormal liver enzymes, may assist in early risk stratification and intensified cardiac surveillance in the acute phase of KD.