COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry

Jerin Jose, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. jtj17@alumni.utsw.edu.
Elif Seda Tierney, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
Ashraf S. Harahsheh, Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Canada.
Geetha Raghuveer, Children's Mercy Hospital, Kansas City, MO, USA.
Kevin G. Friedman, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Michael Khoury, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
Mark D. Hicar, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Shae A. Merves, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA.
Frederic Dallaire, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Pedrom Farid, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Cedric Manlhiot, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Kyle Runeckles, Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, ON, Canada.
Nilanjana Misra, Cohen Children's Medical Center of NY, Northwell Health, Queens, NY, USA.
Michael Portman, Seattle Children's Hospital, Seattle, WA, USA.
Jean A. Ballweg, Children's Hospital & Medical Center of Omaha, Omaha, NE, USA.
Simon Lee, The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
Supriya S. Jain, New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh SOM, Pittsburgh, PA, USA.
Jacqueline R. Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
William Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, USA.
Guillermo Larios, Pontificia Universidad Católica de Chile, Región Metropolitana, Santiago, Chile.
Brian W. McCrindle, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Document Type

Journal Article

Publication Date

2-14-2023

Journal

Pediatric cardiology

DOI

10.1007/s00246-023-03109-w

Keywords

COVID-19; Kawasaki; MIS-C; MIS-C with KD phenotype; SARS-CoV-2

Abstract

To determine clinical differences for children with complete Kawasaki disease (KD) with and without evidence of preceding SARS-CoV-2 infection. From January 2020, contemporaneous patients with complete KD criteria were classified as either SARS-CoV-2 positive (KDCOVID+; confirmed household exposure, positive PCR and/or serology) or SARS-CoV-2 negative (KDCOVID-; negative testing and no exposure) and compared. Of 744 patients in the International Kawasaki Disease Registry, 52 were KDCOVID- and 61 were KDCOVID+. KDCOVID+ patients were older (median 5.5 vs. 3.7 years; p < 0.001), and all additionally met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C). They were more likely to have abdominal pain (60% vs. 35%; p = 0.008) and headache (38% vs. 10%; p < 0.001) and had significantly higher CRP, troponin, and BUN/creatinine, and lower hemoglobin, platelets, and lymphocytes. KDCOVID+ patients were more likely to have shock (41% vs. 6%; p < 0.001), ICU admission (62% vs. 10%; p < 0.001), lower left ventricular ejection fraction (mean lowest LVEF 53% vs. 60%; p < 0.001), and to have received inotropic support (60% vs. 10%; p < 0.001). Both groups received IVIG (2 doses in 22% vs. 18%; p = 0.63), but KDCOVID+ were more likely to have received steroids (85% vs. 35%; p < 0.001) and anakinra (60% vs. 10%; p = 0.002). KDCOVID- patients were more likely to have medium/large coronary artery aneurysms (CAA, 12% vs. 0%; p = 0.01). KDCOVID+ patients differ from KDCOVID-, have more severe disease, and greater evidence of myocardial involvement and cardiovascular dysfunction rather than CAA. These patients may be a distinct KD phenotype in the presence of a prevalent specific trigger.

Department

Pediatrics

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