Objective: Coronary artery lesion (CAL) is a serious complication of Kawasaki disease (KD). Whether there is CAL and the severity are the most critical factors of the prognosis of KD. The incidence of KD is currently increasing year by year. KD has replaced rheumatic fever as the main entity of acquired heart disease of children. This study aimed to identify risk factors of CAL secondary to KD and take early interventions to prevent CAL or reduce its incidence.
Method: Literature search was performed at Chinese Academic Literature Main Database, Chinese Science and Technology Periodical Database, Wanfang Periodicals and Dissertation Database, and the Chinese Biomedical Literature Database comprehensively, besides, retrospective retrieval and manual retrieval were also performed from the domestic public actions and the dissertations dating from January, 2000 to December, 2009. RavMan 4.2 provided by Cochrane was used for meta analysis. Fixed or random model was selected according to the results of heterogeneity test. Sensitivity analysis was done according to the different results. The publication bias was evaluated by funnel plots. Odds ratio (OR) and 95% confidence interval (CI) were estimated in the dissertation.
Result: Twenty studies were confirmed to be eligible. All the 20 studies were retrospective. OR and 95%CI of the risk factors were as follows: age ≤ 1 year, OR = 1.58, and 95%CI (1.23, 2.04), P = 0.0004; male gender, OR = 1.48, 95%CI (1.29, 1.71), P < 0.000 01; WBC > 20 × 10(9)/L, OR = 1.73, 95%CI (1.32, 2.26), P < 0.0001; C-reactive protein (CRP) > 100 mg/L, OR = 2.37, 95%CI (1.49, 3.77), P = 0.0003; fever duration > 10 d, OR = 3.23, 95%CI (2.08, 5.02), P < 0.000 01; use of intravenous gamma globulin (IVIG) > 10 d, OR = 2.50, 95%CI (1.98, 3.16), P < 0.000 01.
Conclusion: The high risk factors for coronary artery lesion secondary to Kawasaki disease are age ≤ 1 year, male, WBC > 20 × 10(9)/L, CRP > 100 mg/L, fever duration>10 d, and use of intravenous gamma globulin (IVIG) > 10 d.