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.
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