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Paediatric Rheumatology

 

Convergence and divergence in Kawasaki disease and multisystem inflammatory syndrome in children: results from the COVASAKI survey

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18

 

  1. Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, and NEUROFARBA Department, University of Florence, Italy. maria.mastrolia@unifi.it
  2. Paediatric Unit, San Donato Hospital, Arezzo, Italy.
  3. Division of Neonatology and Paediatrics, Apuane Hospital, Massa Carrara, AUSL Toscana Nord Ovest, Pisa, Italy.
  4. Paediatric Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, AUSL Toscana Centro, Firenze, Italy.
  5. Paediatric Unit, San Giuseppe Hospital, Empoli, Italy.
  6. Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Italy.
  7. Section of Clinical and Laboratory Immunology, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
  8. Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, Italy.
  9. Paediatric Unit, San Jacopo Hospital, Pistoia, Italy.
  10. Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, and NEUROFARBA Department, University of Florence, Italy.
  11. Paediatric Unit, Misericordia Hospital, Grosseto, Italy.
  12. Paediatric Immunology Unit, Meyer Children’s Hospital IRCCS, Firenze; and Department of Health Sciences, University of Florence, Italy.
  13. Cardiology Unit, Meyer Children's Hospital IRCCS, Firenze, Italy.
  14. Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, Italy.
  15. NEUROFARBA Department, University of Florence, and Paediatric Unit, Meyer Children's Hospital IRCCS, Firenze, Italy.
  16. Paediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Firenze, Italy.
  17. Department of Health Sciences, University of Florence, and Paediatric Unit, Meyer Children’s Hospital IRCCS, Firenze, Italy.
  18. Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, and NEUROFARBA Department, University of Florence, Italy.

CER17185
2024 Vol.42, N°4
PI 0931, PF 0936
Paediatric Rheumatology

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PMID: 38683206 [PubMed]

Received: 03/10/2023
Accepted : 04/01/2024
In Press: 29/04/2024
Published: 29/04/2024

Abstract

OBJECTIVES:
To compare Kawasaki disease (KD) and multisystem inflammatory syndrome (MIS-C) in children.
METHODS:
Prospective collection of demographics, clinical and treatment data. Assessment of type 1 interferon (IFN) score, CXCL9, CXCL10, Interleukin (IL)18, IFNγ, IL6, IL1b at disease onset and at recovery.
RESULTS:
87 patients (43 KD, 44 MIS-C) were included. Age was higher in MIS-C compared to KD group (mean 31±23 vs. 94±50 months, p<0.001). Extremities abnormalities (p=0.027), mucosal involvement (p<0.001), irritability (p<0.001), gallbladder hydrops (p=0.01) and lymphadenopathy (p=0.07) were more often recorded in KD. Neurological findings (p=0.002), gastrointestinal symptoms (p=0.013), respiratory involvement (p=0.019) and splenomegaly (p=0.026) were more frequently observed in MIS-C. Cardiac manifestations were higher in MIS-C (p<0.001), although coronary aneurisms were more frequent in KD (p=0.012). In the MIS-C group, the multiple linear regression analysis revealed that a higher IFN score at onset was related to myocardial disfunction (p<0.001), lymphadenopathy (p=<0.001) and need of ventilation (p=0.024). Both CXCL9 and CXCL10 were related to myocardial disfunction (p<0.001 and p=0.029). IL18 was positively associated to PICU admission (0.030) and ventilation (p=004) and negatively associated to lymphadenopathy (0.004). IFNγ values were related to neurological involvement and lymphadenopathy (p<0.001), IL1b to hearth involvement (0.006). A negative correlation has been observed between IL6 values, heart involvement (p=0.013) and PICU admission (p<0.001).
CONCLUSIONS:
The demographic and clinical differences between KD e MIS-C cohorts confirm previous reported data. The assessment of biomarkers levels at MIS-C onset could be useful to predict a more severe disease course and the development of cardiac complications.

DOI: https://doi.org/10.55563/clinexprheumatol/l64q51

Rheumatology Article