2017, Number 3
The Harada score must not be used as a predictor of coronary aneurysms in Mexican children with Kawasaki disease: analysis of the Surveillance Network of Kawasaki in Mexico
Full text
Language: Spanish
References: 10
Page: 92-100
PDF size: 317.47 Kb.
ABSTRACT
Objectives: To evaluate if the criteria of the Harada score (HS) are useful as predictors of coronary aneurysm in a population of Mexican children with Kawasaki disease. Material and methods: We carried out a review of the clinical records of children with a diagnosis of KD who developed coronary aneurysms, and who were cared for in nine hospitals of the Mexican Republic from January 2008 to December 2012; we assessed their HS, which includes the following criteria: 1. Leukocyte count › 12,000/mm3; 2. Platelet count ‹ 350,000/mm3; 3. CRP › 3; 4. Hematocrit ‹ 35%; 5. Albumin ‹ 3.5 g/dL; 6. Age ≤ 12 months, and 7. Male sex. It is positive when the patient presents four of these criteria. All the patients studied had an echocardiogram in the acute phase, and at least another during evolution. Results: We studied 179 patients, 111 male (62%), aged 2 months to 18 years. Thirty-five patients with HS of three or less (76%) and twenty-eight with HS of four or more (100%) had a lesion in the coronary arteries: 21, coronary aneurysm (15 of them in both coronary arteries) and 11, coronary ectasia (associated with an aneurysm in another coronary in four). There were only six patients with a score of five. The HS had a sensitivity of 21%, a specificity of 52%, a positive predictive value of 22% and a negative predictive value of 86%. Conclusions: The HS in a child with KD is useful since it can be a predictor of high risk for developing coronary aneurysms when the value is greater than four, and of very high risk when it is five. Nevertheless, children with HS of three or less must have a closer follow-up, with frequent echocardiograms, since the HS is not reliable.REFERENCES
Harada K, Yamaguchi H, Kato H, Nishibayashi Y, Ichiro S, Okazaki T et al. Indication for intravenous gammaglobulin treatment for Kawasaki disease. In: Takahashi M, Taubert K, eds. Proceedings of the Fourth International Symposium on Kawasaki disease. Dallas, Tex: American Heart Association; 1993. pp. 459-462.
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC et al. Diagnosis, treatment, and long-term management of Kawasaki disease, a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004; 110: 2747-2771.