Treatments Distinct for Black and White Children With Kawasaki Disease

Kawasaki Disease Child Hand
Kawasaki Disease Child Hand
Clinical outcomes of and treatment for Kawasaki disease were found to be distinct for Black and White children.

Clinical outcomes of and treatment for Kawasaki disease (KD) were found to be distinct for Black and White children despite similar time to diagnosis and initial treatment, according to a retrospective study published in the Journal of Pediatrics.

Researchers searched clinical records (N=369) from the Children’s of Alabama hospital for children diagnosed with KD between 2000 and 2015. Clinical outcomes and treatments were compared between White (n=192) and Black (n=177) children.

White vs Black children presenting to the hospital with KD were more likely to have conjunctivitis (66.7% vs 55.4%, respectively; P =.02) or rash (72.4% vs 58.2%, respectively; P =.004). White and Black children also had distinct baseline laboratory variables:  hemoglobin (11.2±1.2 g/dL vs 10.6±1.2 g/dL, respectively; P <.0001), hematocrit (32.5%±3.1% vs 31.2±3.3%, respectively; P =.0002), erythrocyte sedimentation rate (58.5±29.1 mm/hour vs 70±33.5 mm/hour, respectively; P =.0007), potassium (4±0.5 meq/L vs 4.2±0.6 meq/L, respectively; P =.04), sodium (138.4±3.1 meq/L vs 136.5±3.4 meq/L, respectively; P <.0001), albumin (3.6±0.5 g/dL vs 3.4±0.5 g/dL, respectively; P =.001), and creatinine (0.37±0.13 mg/dL vs 0.42±0.17 mg/dL, respectively; P =.01).

Within 10 days of fever onset, 94% of Black children and 89.7% of White children received an intravenous gamma globulin (IVIG) infusion (P =.12). Response to IVIG was lower (P =.007) among Black vs White children (86.6% vs 95.6%, respectively; P =.007).

Alternative therapies were administered more often to Black vs White children (9.6% vs 2.6%, respectively; P =.003) and fewer were untreated (2.8% vs 7.3%, respectively; P =.04). Black children had longer hospital stays compared with White children (4.5±3.9 days vs 3.4±2.2 days, respectively; P =.002).

The time to first electrocardiogram was comparable for Black and White children (P =.15). A greater percentage of Black vs White children had abnormal results on their second (14.5% vs 6.3%, respectively; P =.03) and third (21.2% vs 6.9%, respectively; P =.01) electrocardiogram.

Major study limitations include its retrospective nature, and the lack of follow-up laboratory data for most patients.

“For the most part, race has rarely been accounted for in predictive models [of KD] or during statistical analyses for clinical trials. Therefore, evaluation of these risks scores by race, specifically in Blacks is warranted,” concluded the study authors.

Reference

Padilla L A, Collins J L, Idigo A J, et al. Kawasaki disease and clinical outcome disparities among Black children. J Pediatr. 2020;S0022-3476(20)31244-0. doi:10.1016/j.jpeds.2020.09.052