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- Title
Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children.
- Authors
Khoury, Michael; Harahsheh, Ashraf S.; Raghuveer, Geetha; Dahdah, Nagib; Lee, Simon; Fabi, Marianna; Selamet Tierney, Elif Seda; Portman, Michael A.; Choueiter, Nadine F.; Elias, Matthew; Thacker, Deepika; Dallaire, Frédéric; Orr, William B.; Harris, Tyler H.; Norozi, Kambiz; Truong, Dongngan T.; Khare, Manaswitha; Szmuszkovicz, Jacqueline R.; Pagano, Joseph J.; Manlhiot, Cedric
- Abstract
Key Points: Question: What is the prevalence of obesity and association with clinical presentation and outcomes in children with Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C)? Findings: In this cohort study including 1767 patients with KD or MIS-C, the prevalence of overweight and obesity was significantly higher in patients with MIS-C compared with KD (41% vs 23%). Obesity was not associated with most clinical presentations or outcomes in patients with KD, but was associated with a more severe presentation and worsened outcomes in patients with MIS-C. Meaning: The findings of this study suggest that obesity is a comorbid factor that should be considered at the clinical presentation in children with MIS-C. Importance: Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Objective: To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. Design, Setting, and Participants: In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. Main Outcomes and Measures: Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. Results: Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P <.001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. Conclusions and Relevance: In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C. This cohort study examines the prevalence of obesity and its association with clinical outcomes in children with Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
- Subjects
CANADA; MULTISYSTEM inflammatory syndrome; COVID-19; CHILDHOOD obesity; SYMPTOMS; DISEASE prevalence; DESCRIPTIVE statistics; MUCOCUTANEOUS lymph node syndrome; COMORBIDITY; LONGITUDINAL method; DISEASE complications; CHILDREN
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2346829
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.46829