NYMC Faculty Publications

Kawasaki Disease in the Time of COVID-19 and Mis-C: The International Kawasaki Disease Registry

Ashraf S. Harahsheh, Division of Cardiology, Department of Pediatrics, Children's National Hospital; George Washington University School of Medicine and Health Sciences; Washington, DC, USA. Electronic address: aharahsh@childrensnational.org.
Samay Shah, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Frederic Dallaire, Department of Paediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland, USA.
Michael Khoury, Division of Paediatric Cardiology, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.
Simon Lee, The Heart Center at Nationwide Children's Hospital, Columbus, Ohio, USA.
Marianna Fabi, Paediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
Daniel Mauriello, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA.
Elif Seda Tierney, Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California, USA.
Arash A. Sabati, Phoenix Children's Hospital, Phoenix, Arizona, USA.
Audrey Dionne, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nagib Dahdah, Division of Paediatric Cardiology, CHU Ste-Justine, University of Montréal, Montréal, Québec, Canada.
Nadine Choueiter, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
Deepika Thacker, Nemours Children's Hospital, Wilmington, Delaware, USA.
Therese M. Giglia, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Dongngan T. Truong, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA.
Supriya Jain, New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
Michael Portman, Seattle Children's Hospital, Seattle, Washington, USA.
William B. Orr, Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jacqueline R. Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, California, USA.
Pedrom Farid, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Brian W. McCrindle, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Author Type(s)

Faculty

Journal Title

The Canadian Journal of Cardiology

First Page

58

Last Page

72

Document Type

Article

Publication Date

1-1-2024

Department

Pediatrics

Abstract

BACKGROUND: Patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. METHODS: The International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS: Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. CONCLUSIONS: There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.

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