Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children
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Published:2023-12-08
Issue:12
Volume:6
Page:e2346829
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Khoury Michael1, Harahsheh Ashraf S.2, Raghuveer Geetha3, Dahdah Nagib4, Lee Simon5, Fabi Marianna6, Selamet Tierney Elif Seda7, Portman Michael A.8, Choueiter Nadine F.9, Elias Matthew10, Thacker Deepika11, Dallaire Frédéric12, Orr William B.13, Harris Tyler H.14, Norozi Kambiz15, Truong Dongngan T.16, Khare Manaswitha17, Szmuszkovicz Jacqueline R.18, Pagano Joseph J.1, Manlhiot Cedric19, Farid Pedrom20, McCrindle Brian W.20, Alsalehi Mahmoud21, Ballweg Jean A.21, Barnes Benjamin T.21, Braunlin Elizabeth21, Buffone Ashley21, Bustamante-Ogando Juan Carlos21, Chang Arthur J.21, Dancey Paul21, De Ferranti Sarah D.21, Dimes Catherine21, Dionne Audrey21, El Ganzoury Mona21, El Samman Nora21, Fernández Cooke Elisa21, Garrido-Garcia Luis Martin21, Giglia Therese M.21, Goldenberg Guillermo Larios21, Harris Kevin C.21, Hicar Mark D.21, Hidalgo Corral Nicolas M.21, Jain Supriya S.21, Jone Pei-Ni21, Kajimoto Hidemi21, Kutty Shelby21, Lanari Marcello21, Lowndes Robert W.21, Maksymiuk Victoria21, Mauriello Daniel21, McHugh Kimberly E.21, Merves Shae A.21, Misra Nilanjana21, Mohandas Sindhu21, Mondal Tapas21, Nowlen Todd T.21, Prasad Deepa21, Ravi Prasad21, Sabati Arash A.21, Sehgal Anupam21, Shah Ashish21, Sundaram Balasubramanian21, Toral Vázquez Belén21, Tremoulet Adriana H.21, Venkataraman Aishwarya21, Yamazaki-Naksahimada Marco Antonio21, Yetman Anji T.21, Zadokar Varsha21,
Affiliation:
1. Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada 2. Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 3. Children’s Mercy Hospital, Kansas City, Missouri 4. Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada 5. The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio 6. Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy 7. Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, California 8. Seattle Children’s Research Institute, Seattle, Washington 9. Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10. Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 11. Nemours Children’s Hospital, Wilmington, Delaware 12. Department of Pediatrics, Universite de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada 13. Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 14. UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15. Department of Pediatrics, Pediatric Cardiology, Western University, London, Ontario, Canada 16. University of Utah and Primary Children’s Hospital, Salt Lake City 17. University of California San Diego/Rady Children’s Hospital San Diego 18. Children’s Hospital of Los Angeles, Los Angeles, California 19. Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland 20. Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 21. for the International Kawasaki Disease Registry
Abstract
ImportanceObesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.ObjectiveTo compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.Design, Setting, and ParticipantsIn this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.Main Outcomes and MeasuresPatient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.ResultsOf 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.Conclusions and RelevanceIn this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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