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Volume 51, Number 3, June 2018

The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness 


Tsung-Ju Yang, Ming-Tai Lin, Chun-Yi Lu, Jong-Min Chen, Ping-Ing Lee, Li-Min Huang, Mei-Hwan Wu, Luan-Yin Chang


 

Corresponding author:

Correspondence
Corresponding author. Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, 8 Chung-Shan South Road, Taipei 10002, Taiwan. Fax: +886 2 2314 7450. 



 

Background and purpose: 

The use of corticosteroid in Kawasaki disease (KD) remains controversial among current guidelines. The objective of this study is to summarize the effectiveness and safety of corticosteroid to prevent coronary arterial lesions in Kawasaki disease, both as initial and rescue therapy. 



 

Methods:

The Medline, EMBASE, Google scholar, Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov, and Japanese Institutional Repositories Online were searched for studies up to 31 March 2017. Studies that compared incidence of coronary artery lesions between regimens with corticosteroid and regimen without it in a well-defined controlled group were included. The incidence of coronary artery lesion was analyzed by meta-analysis. 



 

Results:

Nineteen studies published between 1999 and 2016 fulfilled eligibility criteria. There were 3591 patients included for analysis. There was a significant reduction in incidence of coronary artery lesions with usage of corticosteroid with a pooled odds ratio of 0.72 (95% CI 0.57–0.92; p = 0.01) than that without usage of corticosteroid. In general, a greater effect was seen in the patient received corticosteroid as initial and adjuvant therapy with intravenous immune globulin (pooled odds ratio 0.39, 95% CI 0.21–0.73, p = 0.007) than those who received corticosteroid as rescue therapy. The risk reduction was statistically significant in Japanese groups (OR 0.56, 95% CI 0.42–0.75 in fixed effects model) but not significant in non-Japanese groups (OR 1.45, 95% CI 0.91–2.30 in fixed effects model). 



 

Conclusion:

We demonstrated an overall reduction in incidence of coronary artery lesions with the use of corticosteroid as initial and adjuvant treatment for Kawasaki disease. 



 

Key words:

Kawasaki disease, Corticosteroid, Coronary artery aneurysms, Coronary artery lesions, Acquired heart disease in children