PMID- 30180185
OWN - NLM
STAT- MEDLINE
DCOM- 20190417
LR  - 20191210
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 9
DP  - 2018
TI  - Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?
PG  - e0202658
LID - 10.1371/journal.pone.0202658 [doi]
LID - e0202658
AB  - BACKGROUND: Kawasaki disease (KD) is a febrile systemic vasculitis of unknown 
      etiology and the main cause of acquired heart disease among children in the 
      developed world. To date, abdominal involvement at presentation is not recognized 
      as a risk factor for a more severe form of the disease. OBJECTIVE: To evaluate 
      whether presenting abdominal manifestations identify a group at major risk for 
      Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. METHODS: 
      Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 
      pediatric units in Italy. Patients were divided into 2 groups according to the 
      presence or absence of abdominal manifestations at onset. We compared their 
      demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, 
      laboratory findings from the acute and subacute phases. RESULTS: 302 patients 
      (181 boys) were enrolled: 106 patients with, and 196 patients without presenting 
      abdominal features. Seasonality was different between the groups (p = 0.034). 
      Patients with abdominal manifestations were younger (p = 0.006) and more 
      frequently underwent delayed treatment (p = 0.014). In the acute phase, patients 
      with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and 
      lower albuminemia (p = 0.009), while, in the subacute phase, they had higher 
      white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and 
      lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). 
      Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 
      0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, 
      presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, 
      delayed treatment and albumin concentration in the acute phase were independent 
      risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 
      0.009). CONCLUSIONS: This is the first multicenter report demonstrating that 
      presenting gastrointestinal features in KD identify patients at higher risk for 
      IVIG-resistance and for the development of coronary aneurysms in a predominantly 
      Caucasian population. CLINICAL TRIAL REGISTRATION: 8/20014/O/OssN.
FAU - Fabi, Marianna
AU  - Fabi M
AD  - Pediatric Cardiology and Adult Congenital Unit, University of Bologna, 
      S.Orsola-Malpighi Hospital, Bologna, Italy.
FAU - Corinaldesi, Elena
AU  - Corinaldesi E
AD  - Department of Pediatrics, Ramazzini Hospital, Carpi, Italy.
FAU - Pierantoni, Luca
AU  - Pierantoni L
AD  - Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, 
      Bologna, Italy.
FAU - Mazzoni, Elisa
AU  - Mazzoni E
AD  - Department of Pediatrics, Maggiore Hospital, Bologna, Italy.
FAU - Landini, Chiara
AU  - Landini C
AD  - Department of Pediatrics, Maggiore Hospital, Bologna, Italy.
FAU - Bigucci, Barbara
AU  - Bigucci B
AD  - Department of Pediatrics, Infermi Hospital, Rimini, Italy.
FAU - Ancora, Gina
AU  - Ancora G
AD  - Department of Pediatrics, Infermi Hospital, Rimini, Italy.
FAU - Malaigia, Laura
AU  - Malaigia L
AD  - Department of Pediatrics, Bufalini Hospital, Cesena, Italy.
FAU - Bodnar, Tetyana
AU  - Bodnar T
AUID- ORCID: 0000-0002-2727-3506
AD  - Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, 
      Bologna, Italy.
FAU - Di Fazzio, Giorgia
AU  - Di Fazzio G
AD  - Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, 
      Italy.
FAU - Lami, Francesca
AU  - Lami F
AD  - Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, 
      Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, 
      Italy.
FAU - Valletta, Enrico
AU  - Valletta E
AD  - Department of Pediatrics, G.B.Morgagni-L. Pierantoni Hospital, AUSL della 
      Romagna, Forli, Italy.
FAU - Cicero, Cristina
AU  - Cicero C
AD  - Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy.
FAU - Biasucci, Giacomo
AU  - Biasucci G
AD  - Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy.
FAU - Iughetti, Lorenzo
AU  - Iughetti L
AD  - Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, 
      Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, 
      Italy.
FAU - Marchetti, Federico
AU  - Marchetti F
AD  - Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, 
      Ravenna, Italy.
FAU - Sogno Valin, Paola
AU  - Sogno Valin P
AD  - Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy.
FAU - Amarri, Sergio
AU  - Amarri S
AD  - Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, 
      Italy.
FAU - Brusa, Sandra
AU  - Brusa S
AD  - Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy.
FAU - Sprocati, Monica
AU  - Sprocati M
AD  - Department of Pediatrics, Arcispedale Sant'Anna, Ferrara, Italy.
FAU - Maggiore, Giuseppe
AU  - Maggiore G
AD  - Department of Pediatrics, Arcispedale Sant'Anna, Ferrara, Italy.
FAU - Dormi, Ada
AU  - Dormi A
AD  - Department of Medical and Surgical Sciences DIMEC, University of Bologna, 
      Bologna, Italy.
FAU - Lanzoni, Paolo
AU  - Lanzoni P
AD  - Department of Pediatrics, Ramazzini Hospital, Carpi, Italy.
FAU - Donti, Andrea
AU  - Donti A
AD  - Pediatric Cardiology and Adult Congenital Unit, University of Bologna, 
      S.Orsola-Malpighi Hospital, Bologna, Italy.
FAU - Lanari, Marcello
AU  - Lanari M
AD  - Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, 
      Bologna, Italy.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180904
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Serum Albumin)
SB  - IM
MH  - Abdominal Pain
MH  - Age Factors
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Coronary Aneurysm/*epidemiology
MH  - Dilatation, Pathologic
MH  - Drug Resistance
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Infant
MH  - Italy
MH  - Male
MH  - Mucocutaneous Lymph Node Syndrome/blood/*diagnosis/*epidemiology
MH  - Platelet Count
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Serum Albumin/analysis
MH  - Vomiting
PMC - PMC6122791
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/09/05 06:00
MHDA- 2019/04/18 06:00
PMCR- 2018/09/04
CRDT- 2018/09/05 06:00
PHST- 2018/01/02 00:00 [received]
PHST- 2018/08/07 00:00 [accepted]
PHST- 2018/09/05 06:00 [entrez]
PHST- 2018/09/05 06:00 [pubmed]
PHST- 2019/04/18 06:00 [medline]
PHST- 2018/09/04 00:00 [pmc-release]
AID - PONE-D-18-00067 [pii]
AID - 10.1371/journal.pone.0202658 [doi]
PST - epublish
SO  - PLoS One. 2018 Sep 4;13(9):e0202658. doi: 10.1371/journal.pone.0202658. 
      eCollection 2018.