Predictors of coronary artery aneurysm in Kawasaki disease
Keywords:
Kawasaki Disease, Coronary Artery Aneurysm, Risk Factors, Risk AssessmentAbstract
Background: Kawasaki disease (KD) is an acute medium-vessel vasculitis and the leading cause of acquired heart disease in children. Coronary artery aneurysm (CAA) is the most serious complication and remains a major source of morbidity. Early identification of patients at risk for CAA is therefore essential.
Objectives: To identify clinical and laboratory predictors of coronary artery aneurysm in Kawasaki disease and to develop a practical risk score.
Methods: A retrospective cohort study was conducted in children diagnosed with Kawasaki disease at Nakornping Hospital, Chiang Mai, between July 2016 and October 2025. Clinical characteristics, laboratory parameters, echocardiographic findings, and treatment responses were reviewed. Independent predictors of CAA were identified using multivariable binary logistic regression. A weighted risk score was derived, and model performance was assessed using the area under the receiver operating characteristic curve (AuROC).
Results: Of 230 patients, 99 (43.0%) developed coronary artery aneurysm. Male sex, age <1 year old, elevated C-reactive protein, hypoalbuminemia, and IVIG resistance were independently associated with CAA (all p value <0.05). A risk score (0–7.5 points) classified patients into low (<2 points), moderate (2.5–5.5 points), and high (>6 points) risk groups, with increasing CAA incidence across categories. The model showed acceptable discrimination (AuROC 0.71, 95% CI:0.65-0.78) and reasonable calibration.
Conclusion: This study identifies key predictors of coronary artery aneurysm in Kawasaki disease and proposes a simple risk score based on routinely available parameters. The score may assist early risk stratification and guide closer surveillance. Prospective external validation is required.
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