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

Jerin Jose; Elif Seda Selamet Tierney; Ashraf S. Harahsheh; Nagib Dahdah; Geetha Raghuveer; Kevin G. Friedman; Michael Khoury; Mark D. Hicar; Shae A. Merves; Frederic Dallaire; Pedrom Farid; Cedric Manlhiot; Kyle Runeckles; Nilanjana Misra; Michael Portman; Jean A. Ballweg; Simon Lee; Supriya S. Jain; Tyler H. Harris; Jacqueline R. Szmuszkovicz; William Orr; Guillermo Larios; Brian W. McCrindle

doi:10.1007/s00246-023-03109-w

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

Jerin Jose^*, Elif Seda Selamet Tierney, Ashraf S. Harahsheh, Nagib Dahdah, Geetha Raghuveer, Kevin G. Friedman, Michael Khoury, Mark D. Hicar, Shae A. Merves, Frederic Dallaire, Pedrom Farid, Cedric Manlhiot, Kyle Runeckles, Nilanjana Misra, Michael Portman, Jean A. Ballweg, Simon Lee, Supriya S. Jain, Tyler H. Harris, Jacqueline R. SzmuszkoviczWilliam Orr, Guillermo Larios, Brian W. McCrindle

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1373-1381
Number of pages	9
Journal	Pediatric cardiology
Volume	44
Issue number	6
DOIs	https://doi.org/10.1007/s00246-023-03109-w
State	Published - Aug 2023

Funding

The International Kawasaki Disease Registry (IKDR) is grateful for the hard work of the multiple research coordinators, research nurses and students who collected the data for this registry across all participating centers. The IKDR specifically wishes to thanks: Sam Ali (The Hospital for Sick Children, Toronto, Ontario, Canada), Annette L. Baker (Boston Children's Hospital, Boston, Massachusetts, USA), Bailey Bernknopf (The Hospital for Sick Children, Toronto, Ontario, Canada), Tanveer Collins (Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada), Andrea Dahoud (CHU Ste-Justine, University of Montreal, Quebec, Canada), Sarah D. De Ferranti (Boston Children's Hospital, Boston, Massachusetts, USA), Catherine Dimes (Nationwide Children’s Hospital, Columbus, OH, USA), Jacobo Borovoy Gurvich (Hospital Angeles Lomas, Huixquilucan, Mexico), Elías Duck-Hernández (Hospital Angeles Lomas, Huixquilucan, Mexico), Emanuele Filice (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Francesco Ghiazza (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Mercy Joanna Granda-Jiménez (Instituto Nacional de Pediatria, Mexico City, Mexico), Kelli Kaneta (Children's Hospital of Los Angeles, Los Angeles, California, USA), Simran Mahanta (Boston Children's Hospital, Boston, Massachusetts, USA), Irene Emita Maulen-Radovan (Hospital Angeles Lomas, Huixquilucan, Mexico), Jane W. Newburger (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Sunita O’Shea (The Hospital for Sick Children, Toronto, Ontario, Canada), Mounica Rao (Children's Hospital of Los Angeles, Los Angeles, California, USA), Itzel Estefani Ríos-Olivares (Instituto Nacional de Pediatria, Mexico City, Mexico), Kristine Rutt (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Seaher Sakha (The Hospital for Sick Children, Toronto, Ontario, Canada), Christopher Schmitt (Children's Hospital of Los Angeles, Los Angeles, California, USA), Pablo Tietzsch Escalante (Hospital Angeles Lomas, Huixquilucan, Mexico). *International Kawasaki Disease Registry List of additional members of the International Kawasaki Disease Registry (IKDR). We acknowledge our IKDR Members (in alphabetical order): Leigh Anne Allwood Newhook MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Elizabeth Braunlin MD, PhD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Ashley Buffone (Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Canada), Juan Carlos Bustamante-Ogando MD (Hospital Angeles Lomas, Huixquilucan, Mexico), Arthur J. Chang MD (Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA), Katherine Connell BA, MS (The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA), Audrey Dionne MD (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Mariana Fabi MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Luis Martin Garrido-Garcia MD, MSc (Hospital Angeles Lomas, Huixquilucan, Mexico and Instituto Nacional de Pediatria, Mexico City, Mexico), Michelle Hite (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Pei-Ni Jone MD (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Hidemi Kajimoto MD, PhD (Seattle Children’s Hospital, Seattle, WA, USA), Stacie Knutson MD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Marcello Lanari MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Robert W. Lowndes (Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA), Victoria Maksymiuk (New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA), Kimberly E. McHugh MD (Medical University of South Carolina, Charleston, SC, USA), Sindhu Mohandas MD (Children's Hospital of Los Angeles, Los Angeles, California, USA), Kambiz Norozi MD, PhD (Department of Paediatrics, Western University, London, Ontario, Canada), Deepa Prasad MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Prasad Ravi MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Anupam Sehgal MD, DNB (Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada), Paul M. Seib MD (University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arizona, USA), Ryan M. Serrano MD (Indiana University School of Medicine, Indianapolis, IN, USA), Suryakant Shah MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Deepika Thacker MD (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA), Marco Antonio Yamazaki-Nakashimada MD (Instituto Nacional de Pediatria, Mexico City, Mexico), Anji T. Yetman MD (Children's Hospital & Medical Center of Omaha, Omaha, NE, USA), Varsha Zadokar MBBS (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA). Funding for the Data Coordinating Centre was partially provided by the CIBC World Market Chair in Child Health Research (Brian McCrindle) and the Labatt Family Heart Centre at SickKids Hospital (Brian McCrindle). Additional local funding for participation in the International Kawasaki Disease Registry (IKDR) was provided by: les Fonds BoBeau Coeur of the Ste-Justine Hospital Foundation (Nagib Dahdah), SUNY Research Seed Grant Program 2019–2020 and by the Wildermuth Memorial Foundation through ‘Variety’, the Children's Charity of Buffalo and Western New York (Mark D. Hicar), the McCance Family Foundation (Jane Newburger), R01HL143130 from the National Institutes of Health (Michael Portman).

Keywords

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

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Cardiology and Cardiovascular Medicine

Access to Document

10.1007/s00246-023-03109-w

Cite this

Jose, J., Tierney, E. S. S., Harahsheh, A. S., Dahdah, N., Raghuveer, G., Friedman, K. G., Khoury, M., Hicar, M. D., Merves, S. A., Dallaire, F., Farid, P., Manlhiot, C., Runeckles, K., Misra, N., Portman, M., Ballweg, J. A., Lee, S., Jain, S. S., Harris, T. H., ... McCrindle, B. W. (2023). COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry. Pediatric cardiology, 44(6), 1373-1381. https://doi.org/10.1007/s00246-023-03109-w

@article{382cd10d29f54c90bc44045b5d4ec92d,

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

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.",

keywords = "COVID-19, Kawasaki, MIS-C, MIS-C with KD phenotype, SARS-CoV-2",

author = "Jerin Jose and Tierney, {Elif Seda Selamet} and Harahsheh, {Ashraf S.} and Nagib Dahdah and Geetha Raghuveer and Friedman, {Kevin G.} and Michael Khoury and Hicar, {Mark D.} and Merves, {Shae A.} and Frederic Dallaire and Pedrom Farid and Cedric Manlhiot and Kyle Runeckles and Nilanjana Misra and Michael Portman and Ballweg, {Jean A.} and Simon Lee and Jain, {Supriya S.} and Harris, {Tyler H.} and Szmuszkovicz, {Jacqueline R.} and William Orr and Guillermo Larios and McCrindle, {Brian W.}",

note = "Funding Information: The International Kawasaki Disease Registry (IKDR) is grateful for the hard work of the multiple research coordinators, research nurses and students who collected the data for this registry across all participating centers. The IKDR specifically wishes to thanks: Sam Ali (The Hospital for Sick Children, Toronto, Ontario, Canada), Annette L. Baker (Boston Children's Hospital, Boston, Massachusetts, USA), Bailey Bernknopf (The Hospital for Sick Children, Toronto, Ontario, Canada), Tanveer Collins (Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada), Andrea Dahoud (CHU Ste-Justine, University of Montreal, Quebec, Canada), Sarah D. De Ferranti (Boston Children's Hospital, Boston, Massachusetts, USA), Catherine Dimes (Nationwide Children{\textquoteright}s Hospital, Columbus, OH, USA), Jacobo Borovoy Gurvich (Hospital Angeles Lomas, Huixquilucan, Mexico), El{\'i}as Duck-Hern{\'a}ndez (Hospital Angeles Lomas, Huixquilucan, Mexico), Emanuele Filice (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Francesco Ghiazza (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Mercy Joanna Granda-Jim{\'e}nez (Instituto Nacional de Pediatria, Mexico City, Mexico), Kelli Kaneta (Children's Hospital of Los Angeles, Los Angeles, California, USA), Simran Mahanta (Boston Children's Hospital, Boston, Massachusetts, USA), Irene Emita Maulen-Radovan (Hospital Angeles Lomas, Huixquilucan, Mexico), Jane W. Newburger (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Sunita O{\textquoteright}Shea (The Hospital for Sick Children, Toronto, Ontario, Canada), Mounica Rao (Children's Hospital of Los Angeles, Los Angeles, California, USA), Itzel Estefani R{\'i}os-Olivares (Instituto Nacional de Pediatria, Mexico City, Mexico), Kristine Rutt (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Seaher Sakha (The Hospital for Sick Children, Toronto, Ontario, Canada), Christopher Schmitt (Children's Hospital of Los Angeles, Los Angeles, California, USA), Pablo Tietzsch Escalante (Hospital Angeles Lomas, Huixquilucan, Mexico). *International Kawasaki Disease Registry List of additional members of the International Kawasaki Disease Registry (IKDR). We acknowledge our IKDR Members (in alphabetical order): Leigh Anne Allwood Newhook MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Elizabeth Braunlin MD, PhD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Ashley Buffone (Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Canada), Juan Carlos Bustamante-Ogando MD (Hospital Angeles Lomas, Huixquilucan, Mexico), Arthur J. Chang MD (Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA), Katherine Connell BA, MS (The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA), Audrey Dionne MD (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Mariana Fabi MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Luis Martin Garrido-Garcia MD, MSc (Hospital Angeles Lomas, Huixquilucan, Mexico and Instituto Nacional de Pediatria, Mexico City, Mexico), Michelle Hite (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Pei-Ni Jone MD (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Hidemi Kajimoto MD, PhD (Seattle Children{\textquoteright}s Hospital, Seattle, WA, USA), Stacie Knutson MD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Marcello Lanari MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Robert W. Lowndes (Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA), Victoria Maksymiuk (New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA), Kimberly E. McHugh MD (Medical University of South Carolina, Charleston, SC, USA), Sindhu Mohandas MD (Children's Hospital of Los Angeles, Los Angeles, California, USA), Kambiz Norozi MD, PhD (Department of Paediatrics, Western University, London, Ontario, Canada), Deepa Prasad MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Prasad Ravi MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Anupam Sehgal MD, DNB (Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada), Paul M. Seib MD (University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arizona, USA), Ryan M. Serrano MD (Indiana University School of Medicine, Indianapolis, IN, USA), Suryakant Shah MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Deepika Thacker MD (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA), Marco Antonio Yamazaki-Nakashimada MD (Instituto Nacional de Pediatria, Mexico City, Mexico), Anji T. Yetman MD (Children's Hospital & Medical Center of Omaha, Omaha, NE, USA), Varsha Zadokar MBBS (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA). Funding Information: Funding for the Data Coordinating Centre was partially provided by the CIBC World Market Chair in Child Health Research (Brian McCrindle) and the Labatt Family Heart Centre at SickKids Hospital (Brian McCrindle). Additional local funding for participation in the International Kawasaki Disease Registry (IKDR) was provided by: les Fonds BoBeau Coeur of the Ste-Justine Hospital Foundation (Nagib Dahdah), SUNY Research Seed Grant Program 2019–2020 and by the Wildermuth Memorial Foundation through {\textquoteleft}Variety{\textquoteright}, the Children's Charity of Buffalo and Western New York (Mark D. Hicar), the McCance Family Foundation (Jane Newburger), R01HL143130 from the National Institutes of Health (Michael Portman). Publisher Copyright: {\textcopyright} 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2023",

month = aug,

doi = "10.1007/s00246-023-03109-w",

language = "English (US)",

volume = "44",

pages = "1373--1381",

journal = "Pediatric cardiology",

issn = "0172-0643",

publisher = "Springer New York",

number = "6",

}

Jose, J, Tierney, ESS, Harahsheh, AS, Dahdah, N, Raghuveer, G, Friedman, KG, Khoury, M, Hicar, MD, Merves, SA, Dallaire, F, Farid, P, Manlhiot, C, Runeckles, K, Misra, N, Portman, M, Ballweg, JA, Lee, S, Jain, SS, Harris, TH, Szmuszkovicz, JR, Orr, W, Larios, G & McCrindle, BW 2023, 'COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry', Pediatric cardiology, vol. 44, no. 6, pp. 1373-1381. https://doi.org/10.1007/s00246-023-03109-w

TY - JOUR

T1 - COVID-19 Positive Versus Negative Complete Kawasaki Disease

T2 - A Study from the International Kawasaki Disease Registry

AU - Jose, Jerin

AU - Tierney, Elif Seda Selamet

AU - Harahsheh, Ashraf S.

AU - Dahdah, Nagib

AU - Raghuveer, Geetha

AU - Friedman, Kevin G.

AU - Khoury, Michael

AU - Hicar, Mark D.

AU - Merves, Shae A.

AU - Dallaire, Frederic

AU - Farid, Pedrom

AU - Manlhiot, Cedric

AU - Runeckles, Kyle

AU - Misra, Nilanjana

AU - Portman, Michael

AU - Ballweg, Jean A.

AU - Lee, Simon

AU - Jain, Supriya S.

AU - Harris, Tyler H.

AU - Szmuszkovicz, Jacqueline R.

AU - Orr, William

AU - Larios, Guillermo

AU - McCrindle, Brian W.

N1 - Funding Information: The International Kawasaki Disease Registry (IKDR) is grateful for the hard work of the multiple research coordinators, research nurses and students who collected the data for this registry across all participating centers. The IKDR specifically wishes to thanks: Sam Ali (The Hospital for Sick Children, Toronto, Ontario, Canada), Annette L. Baker (Boston Children's Hospital, Boston, Massachusetts, USA), Bailey Bernknopf (The Hospital for Sick Children, Toronto, Ontario, Canada), Tanveer Collins (Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada), Andrea Dahoud (CHU Ste-Justine, University of Montreal, Quebec, Canada), Sarah D. De Ferranti (Boston Children's Hospital, Boston, Massachusetts, USA), Catherine Dimes (Nationwide Children’s Hospital, Columbus, OH, USA), Jacobo Borovoy Gurvich (Hospital Angeles Lomas, Huixquilucan, Mexico), Elías Duck-Hernández (Hospital Angeles Lomas, Huixquilucan, Mexico), Emanuele Filice (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Francesco Ghiazza (IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Mercy Joanna Granda-Jiménez (Instituto Nacional de Pediatria, Mexico City, Mexico), Kelli Kaneta (Children's Hospital of Los Angeles, Los Angeles, California, USA), Simran Mahanta (Boston Children's Hospital, Boston, Massachusetts, USA), Irene Emita Maulen-Radovan (Hospital Angeles Lomas, Huixquilucan, Mexico), Jane W. Newburger (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Sunita O’Shea (The Hospital for Sick Children, Toronto, Ontario, Canada), Mounica Rao (Children's Hospital of Los Angeles, Los Angeles, California, USA), Itzel Estefani Ríos-Olivares (Instituto Nacional de Pediatria, Mexico City, Mexico), Kristine Rutt (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Seaher Sakha (The Hospital for Sick Children, Toronto, Ontario, Canada), Christopher Schmitt (Children's Hospital of Los Angeles, Los Angeles, California, USA), Pablo Tietzsch Escalante (Hospital Angeles Lomas, Huixquilucan, Mexico). *International Kawasaki Disease Registry List of additional members of the International Kawasaki Disease Registry (IKDR). We acknowledge our IKDR Members (in alphabetical order): Leigh Anne Allwood Newhook MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Elizabeth Braunlin MD, PhD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Ashley Buffone (Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Canada), Juan Carlos Bustamante-Ogando MD (Hospital Angeles Lomas, Huixquilucan, Mexico), Arthur J. Chang MD (Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA), Katherine Connell BA, MS (The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA), Audrey Dionne MD (Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA), Mariana Fabi MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Luis Martin Garrido-Garcia MD, MSc (Hospital Angeles Lomas, Huixquilucan, Mexico and Instituto Nacional de Pediatria, Mexico City, Mexico), Michelle Hite (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Pei-Ni Jone MD (Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA), Hidemi Kajimoto MD, PhD (Seattle Children’s Hospital, Seattle, WA, USA), Stacie Knutson MD (University of Minnesota Children's Hospital, Minneapolis, MN, USA), Marcello Lanari MD, PhD (Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria, Polyclinic of St. Orsola, University of Bologna, Italy), Robert W. Lowndes (Children's National Health System/George Washington University School of Medicine & Health Sciences, Washington, DC, USA), Victoria Maksymiuk (New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA), Kimberly E. McHugh MD (Medical University of South Carolina, Charleston, SC, USA), Sindhu Mohandas MD (Children's Hospital of Los Angeles, Los Angeles, California, USA), Kambiz Norozi MD, PhD (Department of Paediatrics, Western University, London, Ontario, Canada), Deepa Prasad MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Prasad Ravi MD (Banner Children's at Desert Medical Center, Mesa, Arizona, USA), Anupam Sehgal MD, DNB (Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada), Paul M. Seib MD (University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arizona, USA), Ryan M. Serrano MD (Indiana University School of Medicine, Indianapolis, IN, USA), Suryakant Shah MD (Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada), Deepika Thacker MD (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA), Marco Antonio Yamazaki-Nakashimada MD (Instituto Nacional de Pediatria, Mexico City, Mexico), Anji T. Yetman MD (Children's Hospital & Medical Center of Omaha, Omaha, NE, USA), Varsha Zadokar MBBS (Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital For Children, Wilmington, DE, USA). Funding Information: Funding for the Data Coordinating Centre was partially provided by the CIBC World Market Chair in Child Health Research (Brian McCrindle) and the Labatt Family Heart Centre at SickKids Hospital (Brian McCrindle). Additional local funding for participation in the International Kawasaki Disease Registry (IKDR) was provided by: les Fonds BoBeau Coeur of the Ste-Justine Hospital Foundation (Nagib Dahdah), SUNY Research Seed Grant Program 2019–2020 and by the Wildermuth Memorial Foundation through ‘Variety’, the Children's Charity of Buffalo and Western New York (Mark D. Hicar), the McCance Family Foundation (Jane Newburger), R01HL143130 from the National Institutes of Health (Michael Portman). Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2023/8

Y1 - 2023/8

N2 - 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.

AB - 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.

KW - COVID-19

KW - Kawasaki

KW - MIS-C

KW - MIS-C with KD phenotype

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85148043993&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85148043993&partnerID=8YFLogxK

U2 - 10.1007/s00246-023-03109-w

DO - 10.1007/s00246-023-03109-w

M3 - Article

C2 - 36786810

AN - SCOPUS:85148043993

SN - 0172-0643

VL - 44

SP - 1373

EP - 1381

JO - Pediatric cardiology

JF - Pediatric cardiology

IS - 6

ER -

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

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