Kawasaki disease with gastrointestinal symptoms in children: Clinical characteristics and factors associated with coronary artery lesions

  Background  Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and a common cause of acquired heart disease in children. However, the relationship between presence of digestive symptoms and coronary artery lesions in Kawasaki disease is not clear .

  Objective  To explore the clinical characteristics of gastrointestinal symptoms in children with Kawasaki disease and analyze factors associated with occurrence of coronary artery lesions.

  Methods  Clinical data about children with acute Kawasaki disease diagnosed clearly in the Department of Pediatrics of the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2020 were collected. According to the presence or absence of gastrointestinal symptoms, the children were divided into with gastrointestinal symptoms group and without gastrointestinal symptoms group. The general data, laboratory indicators, and risk factors associated with coronary artery lesions were compared between the two groups.

  Results  Totally 269 cases were selected, including 152 males and 117 females, aged from 2 months to 10 years. There were significant differences in age, cervical lymphadenopathy, coronary artery dilation, delayed treatment with intravenous immunoglobulin (IVIG), white blood cell count, immunoglobulin, serum ferritin, hemoglobin, and complement C4 levels between the two groups (all P＜0.05). Multivariate logistic regression analysis showed that the presence of gastrointestinal symptoms (OR=2.807, 95% CI: 1.055-7.465), age＜6 years (OR=3.806, 95% CI: 1.094-13.234), time of first IVIG injection ≥ 10 d (OR=4.592, 95% CI: 1.095-19.262), platelets ≥400 × 10⁹/L (OR=6.005, 95% CI: 1.619-22.273) were independently associated with concomitant coronary artery disease in children with KD (all P＜0.05).

  Conclusion  Gastrointestinal symptoms in children with Kawasaki disease are more common in infants and toddlers. Gastrointestinal symptoms, age＜6 years, time of first IVIG injection ≥10 d, and platelets≥400 × 10⁹/L are associated with concomitant coronary artery lesions in children with Kawasaki disease.