Table_1_Risk Factors of Coronary Artery Abnormality in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis.docx

While coronary artery abnormality (CAA) has been established as the most serious complication of Kawasaki disease (KD), there have been no detailed systematic reviews of the risk factors associated with this condition. We searched six databases and performed a systematic review and meta-analysis. Study-specific odds ratios (ORs) for each factor were pooled using a random effects model. We identified four risk factors for CAA children with KD: gender (OR, 1.75; 95% confidence interval [CI], 1.59–1.92), intravenous immunoglobulin (IVIG) resistance (OR, 3.43; 95% CI, 2.07–5.67), IVIG treatment beyond 10 days of onset of symptoms (OR, 3.65; 95% CI, 2.23–5.97), and increased C-reactive protein levels (OR, 1.02; 95% CI, 1.01–1.02). More number of the five typical symptoms of KD was identified as a protective factor against CAA (OR, 0.47; 95% CI, 0.33–0.66). Pediatric patients with IVIG resistant were more likely to develop CAA within 1 month of the onset of KD than the general population, even in patients with other risk factors for CAA. Thus, there is a potential risk of CAA misdiagnosis if echocardiography is not carried out frequently. In summary, we report four risk factors for CAA and a protective factor against CAA in children with KD. We recommend that pediatricians consider these factors much more closely. With accurate prediction and early preventive treatment in high-risk patients, we can expect a reduction in CAA rates. Further research is now required to investigate the associations between CAA and other factors including the interval between KD onset and IVIG administration, platelet count, and the duration of fever. We also need to confirm whether the frequency of echocardiography within a month of KD onset should be increased in IVIG-resistant patients.

尽管冠状动脉异常（CAA）已被确立为川崎病（KD）最严重的并发症，但关于与此状况相关的风险因素的详细系统综述尚付阙如。我们对六个数据库进行了检索，并进行了系统综述和荟萃分析。采用随机效应模型对每个因素的研究特定优势比（OR）进行了汇总。我们确定了与KD儿童CAA相关的四个风险因素：性别（OR，1.75；95%置信区间[CI]，1.59–1.92），静脉注射免疫球蛋白（IVIG）耐药性（OR，3.43；95% CI，2.07–5.67），症状出现后10天以上接受IVIG治疗（OR，3.65；95% CI，2.23–5.97），以及C反应蛋白水平升高（OR，1.02；95% CI，1.01–1.02）。更多川崎病的典型症状被认定为CAA的保护性因素（OR，0.47；95% CI，0.33–0.66）。与普通人群相比，即使存在其他CAA风险因素，接受IVIG耐药治疗的儿科患者更可能在KD发病后1个月内发展为CAA。因此，如果未定期进行超声心动图检查，CAA误诊的风险可能增加。总之，我们报道了KD儿童CAA的四个风险因素和一个保护性因素。我们建议儿科医生应更加密切关注这些因素。对于高风险患者，准确的预测和早期预防性治疗有望降低CAA的发生率。目前需要进一步研究CAA与其他因素之间的关联，包括KD发病与IVIG给药之间的间隔、血小板计数和发热持续时间。我们还需要确认KD发病后一个月内是否应增加超声心动图的频率。