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Clinical characteristics of patients with recurrent Kawasaki disease: a nationwide cohort study of 19 456 patients with minimum 3-year follow up
  1. Sin Young Kim1,
  2. Ji Seong Shin1,
  3. Min Sik Jang1,
  4. Jihye Kim1,2
  1. 1Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
  2. 2College of Medicine, Hallym University, Chuncheon, Korea
  1. Correspondence to Professor Jihye Kim, Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea (the Republic of); jihyewiz17{at}kdh.or.kr

Abstract

Objective To identify the clinical characteristics of patients with recurrent Kawasaki disease (KD).

Design A nationwide, population-based, cohort study using the Korean National Health Insurance claims database between 2013 and 2016.

Patients A total of 19 456 patients under the age of 5 years who were diagnosed with initial episode of KD were included. A minimum follow-up period of 3 years was mandatory for inclusion.

Main outcome measures The epidemiological and clinical profiles were compared between KD patients with and without recurrence.

Results The overall recurrence rate of KD was 3.84% (n=748), and the median interval to recurrence was 498 days (IQR: 257–860 days). Approximately 70% of all recurrences occurred within 2 years of the initial diagnosis. The annual proportions of recurrence were 40%, 28%, 18%, 8% and 4% from the first to the fifth year following the initial episode, respectively. Recurrence rates were significantly higher in patients aged <1 year than in those aged 4–5 years (4.65% vs 2.22%) and those who showed resistance to an initial dose of intravenous immunoglobulin (IVIG) (10.00% vs 3.18%). Allergic comorbidities and coronary artery complications at the initial episode were not associated with increased rates of recurrence.

Conclusions We clearly identified the annual recurrence rates and their intervals from the initial episode according to the various factors identified, including young age and resistance to initial IVIG. Our results, based on a nationwide cohort, can be used as reference for follow-up management in patients with KD and in future studies.

  • epidemiology
  • allergy and Immunology
  • infectious disease medicine
  • cardiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Footnotes

  • Contributors JK conceptualised and designed the study. Material preparation, data collection and analysis were performed by SYK, JSS and MSJ. The first draft of the manuscript was written by SYK and JSS. JK and MSJ reviewed and edited the manuscript. All authors contributed to manuscript revision and approved the final article for publication. JK is responsible for the overall content as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.