151 - Corticosteroid Treatment and Coronary Artery Aneurysms Are Not Associated with Worsening BMI Trajectory in Kawasaki Disease Patients

Publication Number: 151.4096

Jessica Laird Gion, Boston Children's Hospital, Brookline, MA, United States; Kimberlee Gauvreau, Boston Children's Hospital, Boston, MA, United States; Jane W.. Newburger, Harvard Medical School/Boston Children's Hospital, Boston, MA, United States; Annette L. Baker, Boston Children's Hospital, Boston, MA, United States; Thomas Giorgio, Boston Children's Hospital, Boston, MA, United States; Lauren Crafts, Boston Children's Hospital, Brookline, MA, United States; Audrey Dionne, Boston Children's Hospital, Boston, MA, United States; Mary Beth F.. Son, Boston Children's Hospital, Brookline, MA, United States; Sarah D.. de Ferranti, Boston Children's Hospital, Boston, MA, United States

Background: Patients with Kawasaki disease (KD) and coronary artery aneurysms (CAA) may be at increased risk for premature cardiovascular disease. Use of corticosteroids as adjunctive treatment in high-risk KD can be associated with weight gain, which would compound risk for cardiovascular disease.

Objective: This study aimed to longitudinally evaluate the BMI trajectory of patients with KD and to determine if there is a relationship between CAA presence, or treatment with corticosteroids, and worsening BMI trajectory.

Design/Methods: We conducted a longitudinal retrospective cohort study of KD patients at a single center (1995 – 2022). We compared BMI z-score between baseline (0-21 days from fever onset), 6 weeks, and 1 year for patients with and without CAA, and with and without corticosteroid treatment.

Results: Among 509 patients with KD (median age 3.6 years, 64% male), mean BMI z-score increased from baseline to 6 weeks by 0.33 ± 0.83 (p < 0.001) but remained stable from 6 weeks to 1 year (0.07 ± 0.86, p=0.064). Among 320 patients followed longitudinally for a median of 8.1 years (range 1.2, 18.2 years), there was no change in BMI z-score after 1 year (mean change per year -0.01, p=0.50). Patients with any CAA (n=164, 32%) did not have a significantly greater change in BMI z-score from baseline to 6 weeks or from 6 weeks to 1 year than those without (0.43 vs 0.28, p=0.071 and 0.02 vs 0.10, p=0.35), Figure 1. Mean change in BMI z- score did not differ between patients with and without aneurysms followed longitudinally (p=0.51). When comparing patients with medium, large, or giant CAA (n=34, 7%) to those without, there was no significant difference in change in BMI z-score between baseline and 6 weeks or between 6 weeks and 1 year (0.44 vs 0.32, p=0.38 and -0.05 vs 0.08, p=0.26). There was no difference in mean BMI z-score change for subjects who did and did not receive corticosteroids baseline to 6 weeks (0.44 vs 0.31, p=0.28) or 6 weeks to 1 year (-0.03 vs 0.08, p=0.38), Figure 2.

Conclusion(s): In our single center study, patients with KD had an increase in BMI z-score in the first 6 weeks after fever onset, perhaps related to poor oral intake at baseline, but reassuringly the effect wanes after 6 weeks. A short course of treatment with corticosteroids in children with high risk KD did not have a lasting adverse impact on BMI z- score at one year, nor did the presence of CAA impact the BMI trajectory in children with KD long term.

Comparison of longitudinal BMI z-scores for Kawasaki disease patients with and without coronary aneurysms
Blue – patients with no coronary artery aneurysms.
Red – patients with small, medium, large, or giant coronary artery aneurysms.

Comparison of BMI z-score at baseline, 6 weeks, and 1 year among Kawasaki disease patients who were treated with corticosteroids and those who were not


Comparison of longitudinal BMI z-scores for Kawasaki disease patients with and without coronary aneurysms
Blue – patients with no coronary artery aneurysms.
Red – patients with small, medium, large, or giant coronary artery aneurysms.

Comparison of BMI z-score at baseline, 6 weeks, and 1 year among Kawasaki disease patients who were treated with corticosteroids and those who were not