Why the study?
To characterise age-specific differences in clinical manifestations, treatment response, and platelet dynamics in Kawasaki disease.
In pediatric patients with Kawasaki disease, treatment delay and elevated platelet distribution width are significant independent predictors of moderate-to-severe cardiovascular damage, highlighting the need for timely intervention and platelet monitoring.
These predictors should not yet change Kawasaki practice; leaves open whether targeting delay or PDW reduces cardiovascular damage.
Objective: To characterise age-specific differences in clinical manifestations, treatment response and platelet dynamics in Kawasaki disease (KD). Methods: A retrospective analysis was conducted on 221 patients with KD who were admitted to the cardiology department of Suzhou Children’s Hospital between June 2015 and May 2016. Patients were divided into three groups based on age: the infant group (≤ 12 months), the toddler group (> 12 months to ≤ 36 months) and the child group (> 36 months to ≤ 10 years). Clinical symptoms, signs, echocardiography (ECHO) findings, treatment characteristics and platelet counts were compared among the groups. Multivariate logistic regression was performed to identify independent predictors of severe cardiovascular damage. A P -value of < 0.05 was considered significant. Results: Major symptoms, such as lymph node enlargement and finger (toe) peeling, were significantly more pronounced in the toddler and child groups ( P < 0.05). The overall incidence of cardiovascular damage was 56.1%, with 31.7% experiencing intravenous immunoglobulin (IVIG) resistance. Treatment delay (≥ 10 days from fever onset) occurred in 18.6% of cases and was associated with increased cardiovascular severity (adjusted odds ratio [aOR] = 2.45, 95% confidence interval [CI] 1.32– 4.56, P = 0.004). Platelet counts and plateletcrit increased significantly during the acute and subacute phases, with the infant group exhibiting significantly higher platelet responses than the toddler and child groups (all P < 0.05). Multivariate analysis revealed that elevated platelet distribution width was independently associated with moderate-to-severe coronary artery lesions (aOR = 1.38, 95% CI 1.09– 1.74, P = 0.007). Conclusion: The clinical characteristics, ECHO findings, treatment patterns and platelet changes in patients with KD exhibit partial age‐related differences. Treatment delay and IVIG resistance significantly impact cardiovascular outcomes. Clinicians are advised to incorporate age-specific diagnostic and treatment strategies, paying particular attention to timely intervention and platelet monitoring to facilitate early recognition and optimise clinical outcomes.
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Wang et al. (2025) studied this question.
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