639 - Epidemiology, Adiposity Status and Severity of Kawasaki Disease in a predominantly Black and African American Urban population.

Publication Number: 639.4611

Anna Tryfonos, SUNY Downstate Health and Sciences University, Brooklyn, NY, United States; Demetris Avraam, University of Copenhagen, Copenhagen, Hovedstaden, Denmark; Siddharth Dubey, NYC Health Hospitals/Kings County Hospital, Forest Hills, NY, United States; Maria-Anna Vastardi, SUNY Downstate Health Sciences University, Brooklyn, NY, United States

Background: Kawasaki disease (KD) is a systemic inflammatory disorder of childhood,common in Asian descent, with predilection for the Coronary Arteries (CA). Obesity, a systemic inflammatory state, is a risk factor for more severe disease and worse outcomes in SARS-CoV2 associated Multisystem Inflammatory Syndrome (MISC), a condition with many similarities with KD. The impact of obesity on disease severity has not been well investigated in KD.

Objective: To describe the basic characteristics of KD in our population and to explore possible association between obesity and KD severity.

Design/Methods: We conducted a retrospective review of electronic medical records of patients 0-18 years old, hospitalized at the State University of New York (SUNY) Downstate / Kings County Hospital Center, with the diagnosis of Kawasaki Disease or Mucocutaneous Lymph Node Syndrome (ICD-9: 446-1, ICD-10: M30.3) from January 1, 2012 to December 31, 2022. We defined adiposity status based on World Health Organization (WHO) weight normative values for ages < 2 years old(YO) and Center for Disease Control (CDC) body mass index (BMI) for >2 YO. Children were categorized into underweight, normal weight, overweight and obese based on weight/BMI percentiles. Disease severity was defined by the median length of hospital stay, IVIG resistance, corticosteroid use, ICU stay, shock pathology at presentation and echocardiographic abnormalities. The inflammatory markers (IM) studied were platelets (peak values and day of peak) and C–Reactive Protein (CRP) max values. We used standard descriptive statistics to describe demographic and clinical features and Mann Whitney U Test to assess for significant differences in disease severity and IM between the two combined adiposity status groups: Underweight & Normal versus Overweight & Obese. P-values < 0.05 were deemed significant.

Results: We identified 55 cases of KD.Ninety-one percent were Black and African American. Over 30% of the children were overweight and obese.The median age of our patients was 24 months (IQR:14.5 – 36) and the male-to-female ratio was 1:1 (Table1). Thirty-one percent of the cases were IVIG resistant (Table 1).There were no statistically significant differences in the disease severity variables (Figure 1) or the inflammatory markers (Figure 2) between the two adiposity status groups (p-values>0.05).

Conclusion(s): Our study gives insight into KD in a predominantly Black and African American population. Increased rate of IVIG resistance was detected. Being overweight or obese was not associated with more severe disease or cardiac findings in KD in our population.

Table 1.Demographics and Clinical Characteristics of Kawasaki Disease.
Abbreviations: IQR: Interquartile Range, KD: Kawasaki Disease, ICU: Intensive Care Unit, CA: Coronary Arteries, MV: Mitral Valve, LV: Left Ventricle, GAS: Group A streptococcus, AOM: Acute Otitis Media, FUO: Fever of Unknown Origin, RSV: Respiratory Syncytial Virus, PTA: Peritonsillar abscess

Figure 1. Disease Severity in Underweight& Normal VS Overweight& Obese Children with Kawasaki Disease.
There is no statistically significant difference in A. ICU Stay(p=0.50), B. Shock Pathology at presentation(p=0.35), C. Length of Hospital Stay (p=0.54), D. Echocardiographic Abnormalities(p=0.55), E. IVIG Resistance(p=0.70) and F. Corticosteroid use(p=0.41) between the 2 different adiposity status categories as depicted in the figures.

Figure 2. Inflammatory Markers in Underweight &Normal VS Overweight &Obese Children with Kawasaki Disease.
There is no statistically significant difference in A. Peak PLT count(p=0.38), B. Day of PLT Peak(p=0.60), C. Peak CRP(p=0.99) between the 2 different adiposity status categories as depicted in the figures.

Table 1.Demographics and Clinical Characteristics of Kawasaki Disease.
Abbreviations: IQR: Interquartile Range, KD: Kawasaki Disease, ICU: Intensive Care Unit, CA: Coronary Arteries, MV: Mitral Valve, LV: Left Ventricle, GAS: Group A streptococcus, AOM: Acute Otitis Media, FUO: Fever of Unknown Origin, RSV: Respiratory Syncytial Virus, PTA: Peritonsillar abscess

Figure 1. Disease Severity in Underweight& Normal VS Overweight& Obese Children with Kawasaki Disease.
There is no statistically significant difference in A. ICU Stay(p=0.50), B. Shock Pathology at presentation(p=0.35), C. Length of Hospital Stay (p=0.54), D. Echocardiographic Abnormalities(p=0.55), E. IVIG Resistance(p=0.70) and F. Corticosteroid use(p=0.41) between the 2 different adiposity status categories as depicted in the figures.

Figure 2. Inflammatory Markers in Underweight &Normal VS Overweight &Obese Children with Kawasaki Disease.
There is no statistically significant difference in A. Peak PLT count(p=0.38), B. Day of PLT Peak(p=0.60), C. Peak CRP(p=0.99) between the 2 different adiposity status categories as depicted in the figures.