Department director Uji Tokusyukai Hospital Takatsuki, Osaka, Japan
Background: Kawasaki disease (KD) is a systemic vasculitis with unknown etiology. Elevated D-dimer level had adverse outcomes of systemic inflammatory conditions. However, there was little information about serial change of D-dimer during acute phase of KD. Objective: To evaluate serial change of D-dimer associated with coronary artery lesion (CAL) in KD. Design/Methods: Between February 2020 and September 2023, a total of 56 children with KD were included in this retrospective study. First, we measured D-dimer level on admission, post intravenous immunoglobulin (IVIG) treatment , at discharge, 30days and 4 months post KD. We enrolled 37 febrile children as a control group. Second, we investigated correlation between Z score of left and right coronary artery diameters and each peak level of blood test results including D-dimer, white blood cell count (WBC), C-reactive protein (CRP), albumin, and platelet counts (PLT) in KD group by using univariate and multivariate logistic regression analysis. Results: D-dimer level on admission (median: day 5) in KD group was significantly higher than that in control group (KD group: 2.0mcg/mL, control group: 0.5mcg/mL, p< 0.001). In serial analysis of D-dimer, D-dimer level was increased against IVIG and median peak day was day 7. Peak D-dimer level was significantly higher than that on admission (on admission: 2.0mcg/mL, peak: 3.1mcg/mL, p< 0.01). D-dimer levels at discharge (p < 0.01), 30days (p < 0.001) and 4 months (p < 0.001) post KD were significantly lower than that on admission. In univariate logistic regression analysis, all blood test results including D-dimer, WBC, CRP, albumin, and PLT on admission, peak CRP and peak PLT did not correlate each Z score of left main coronary trunk (LMT), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). There was moderate correlation between peak D-dimer level and RCA Z score (R=0.49, p< 0.001). Peak WBC level was significantly correlated with Z scores of LMT, LCX and RCA. Minimum albumin level was significantly correlated with Z scores of LAD and LCX. In multivariate logistic regression analysis, peak D-dimer level was independent factor of RCA Z score (regression coefficient: 0.07, 95% CI: 0.029-0.12, p< 0.01). Minimum albumin level was independent factor of LAD Z score (regression coefficient: -0.56, 95% CI: -1.05- -0.08, p< 0.05).
Conclusion(s): Because blood test results on admission did not associate with CAL, serial evaluation of blood test results including D-dimer during acute phase is important and can predict CAL in KD patients.
