# Risk Factors and Regression of Coronary Aneurysms in Infants With Kawasaki Disease

## TL;DR

This study examines risk factors for coronary aneurysms in infants with Kawasaki disease and finds that younger age, male sex, fever duration, and higher CRP levels are linked to aneurysm development, with regression rates varying by aneurysm size.

## Contribution

The study identifies specific risk factors for coronary aneurysm development in infants with KD and quantifies regression rates based on aneurysm size.

## Key findings

- Male sex, fever duration, initial IVIG days, and higher CRP are significant risk factors for coronary aneurysm in infants with KD.
- Giant aneurysms in infants have a higher regression rate compared to older patients with KD.
- Regression rates decrease with aneurysm size, with small aneurysms regressing more frequently and faster than giant ones.

## Abstract

The purpose of this study is to analyze clinical characteristics of patients with Kawasaki disease (KD) aged below 1 year and identify risk factors for coronary aneurysm (CA) and its associated prognosis.

A retrospective study enrolling infants (under 1 year of age) with KD admitted to a children's hospital between January 1, 2012, and August 30, 2024, was conducted. Patients were divided into two groups based on CA presence. Clinical records, including demographics, clinical manifestations, treatments, laboratory parameters, and cardiac ultrasound examination, were collected and analyzed.

Of 381 infants with KD, 96 developed CA. Male sex (adjusted odds ratio [aOR] = 1.982, p = 0.04), duration of fever (aOR = 1.143, p = 0.03), illness days of initial intravenous immunoglobulin (IVIG) (aOR = 1.319, p < 0.01), and higher C-reactive protein (CRP) (aOR = 1.007, p = 0.02) were associated with CA development in infants with KD in multivariable analysis. Specifically, an increase of 10 mg/L in CRP is associated with a 7.2% elevation in risk of CA development. Among patients diagnosed with CA, 30, 42, and 24 had small aneurysm (sAN), medium aneurysm (mAN), and giant aneurysm (gAN), respectively. The complete regression proportion and regression times of sAN, mAN, and gAN were 86.7%, 76.2%, and 33.3% and 3.9 ± 9.2, 12.8 ± 17.2, and 20.7 ± 11.2 months, respectively.

CA incidence was higher in infants with KD and was associated with male sex, fever duration, days of initial IVIG, and higher CRP. The ability and time of regression depend on the size of the CA; however, giant CA in infant patients has a greater tendency to regress than those in older patients with KD.