- Design
- Single-centre longitudinal observational cohort, 1982–2025
- Population
- 533 children with Kawasaki disease, Italy
- Primary outcome
- Coronary aneurysm and long-term coronary sequelae
- Effect
- IVIG resistance OR 9.89; age <6 months OR 7.64; IVIG after day 10 OR 5.27
This single-centre Italian cohort followed 533 consecutive children with Kawasaki disease diagnosed from 1982 to 2025, with echocardiography in the acute phase and annually afterwards. Median age was 26 months. It was published in Pediatrics in September.
Acute coronary involvement occurred in 22%, but only 27 children developed aneurysms; persistent coronary abnormalities occurred exclusively in those with medium or giant aneurysms. Independent predictors of aneurysm were IVIG resistance (OR 9.89), age under six months (OR 7.64), IVIG after day 10 (OR 5.27) and pericardial effusion (OR 3.16). IVIG use rose from 53% in the 1980s to 99% after 2020. No persistent sequelae occurred in high-risk children given interleukin-1 inhibitors.
Two of the four predictors are modifiable: timing and response to IVIG. The practice points are to diagnose early, treat before day 10, and escalate promptly when fever persists after IVIG. The day-10 threshold is the number to hold.
- Give IVIG as soon as Kawasaki is diagnosed, and before day 10 of fever.
- Treat IVIG resistance — fever 36 hours after completion — as a trigger for escalation.
- Identify high-risk children (under six months, pericardial effusion) at diagnosis.
- Arrange specialist follow-up for any child with an aneurysm.
Why it matters
The two strongest modifiable risks for lasting coronary damage are late treatment and unaddressed IVIG resistance.
Don't overread it
The interleukin-1 inhibitor observation is from a few children without a control group.
The statistics, in plain English
With only 27 aneurysms, the odds ratios are imprecise and should be read as direction and rough size. This was a single centre over four decades, during which treatment changed, and the interleukin-1 inhibitor observation involves a small number of children without a comparison group.
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