Incomplete Kawasaki disease (KD) comprises a large proportion of the total number of cases. Although it has the potential of delaying diagnosis, it is not conclusive whether an incomplete presentation is a risk factor for coronary artery abnormalities (CAAs). We performed a meta-analysis to establish the risk of CAA in 20 studies including 4,504 cases and 32,519 controls, and the risk of giant aneurysm in two studies including 5,390 cases and 37,648 controls. The pooled results indicated that incomplete KD was associated with an increased risk of CAA [odds ratio (OR) = 1.447, 95 % confidence interval (CI) = 1.158–1.808, p = 0.001]. Subgroup analyses demonstrated higher associations in patients younger than 12 months (OR = 2.023, 95 % CI = 1.252–3.271, p = 0.004), Asians and Indians (OR = 1.57, 95 % CI = 1.234–1.999, p < 0.001 and OR = 7.088, 95 % CI = 1.640–30.631, p = 0.009, respectively). Subgroup analysis according to the period of patient enrollment before and after 2004 showed increased association of incomplete KD with CAA only among studies with patients enrolled after 2004 (OR = 1.969, 95 % CI = 1.240–3.127, p = 0.004). In conclusion, incomplete KD seems to be associated with an increased risk of CAA, and this is more prominent in patients younger than 12 months, Asians and Indians.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Anderson MS, Todd JK, Glode MP (2005) Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics 115(4):e428–e433
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, New York, pp 77–86
Consul M, Mishra S, Taneja A (2011) Spectrum of Kawasaki disease. Indian J Pediatr 78(4):488–490
Council on Cardiovascular Disease in Young, Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, American Heart Association Council (2001) Diagnostic guidelines for Kawasaki disease. Circulation 103(2):335–336
Fukushige J, Takahashi N, Ueda Y, Ueda K (1994) Incidence and clinical features of incomplete Kawasaki disease. Acta Paediatr 83(10):1057–1060
Generini S, Ermini M, Taccetti G, Trapani S, Cerinic MM, Falcini F (1997) Clinical and laboratory features and disease outcome of Kawasaki disease: the analysis of our experience and literature review. J Clin Rheumatol 3(5):241–247
Ghelani SJ, Sable C, Wiedermann BL, Spurney CF (2012) Increased incidence of incomplete Kawasaki disease at a pediatric hospital after publication of the 2004 American Heart Association Guidelines. PediatrCardiol 33(7):1097–103
Hsieh YC, Wu MH, Wang JK, Lee PI, Lee CY, Huang LM (2002) Clinical features of atypical Kawasaki disease. J Microbiol Immunol Infect 35(1):57–60
Japan Kawasaki Disease Research Committee (1984) Diagnostic guidelines of Kawasaki disease. 4th rev. Japan Kawasaki Disease Research Committee, Tokyo
Joffe A, Kabani A, Jadavji T (1995) Atypical and complicated Kawasaki disease in infants. Do we need criteria? West J Med 162(4):322–327
Kim JJ, Hong YM, Yun SW, Han MK, Lee KY, Song MS, Lee HD, Kim DS, Sohn S, Ha KS, Hong SJ, Kim KJ, Park IS, Jang GY, Lee JK (2012) Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol 33(4):513–520
Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, Son C, Lee J (2007) Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 166(5):421–425
Liu HC, Lo CW, Hwang B, Lee PC (2012) Clinical manifestations vary with different age spectrums in infants with Kawasaki disease. ScientificWorldJournal 2012:210382
Manlhiot C, Christie E, McCrindle BW, Rosenberg H, Chahal N, Yeung RS (2012) Complete and incomplete Kawasaki disease: two sides of the same coin. Eur J Pediatr 171(4):657–662
Nakamura Y, Yashiro M, Sadakane A, Aoyama Y, Oki I, Uehara R, Yanagawa H (2009) Six principal symptoms and coronary artery sequelae in Kawasaki disease. Pediatr Int 51(5):705–708
Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, Ojima T, Yanagawa H (2003) Case–control study of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 45(4):410–413
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110(17):2747–2771
Ozdemir H, Ciftci E, Tapisiz A, Ince E, Tutar E, Atalay S, Dogru U (2010) Clinical and epidemiological characteristics of children with Kawasaki disease in Turkey. J Trop Pediatr 56(4):260–262
Perrin L, Letierce A, Guitton C, Tran TA, Lambert V, Kone-Paut I (2009) Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine 76(5):481–485
Rosenfeld EA, Corydon KE, Shulman ST (1995) Kawasaki disease in infants less than one year of age. J Pediatr 126(4):524–529
Sabharwal T, Manlhiot C, Benseler SM, Tyrrell PN, Chahal N, Yeung RS, McCrindle BW (2009) Comparison of factors associated with coronary artery dilation only versus coronary artery aneurysms in patients with Kawasaki disease. Am J Cardiol 104(12):1743–1747
Singh-Grewal D, Wong M, Isaacs D (2005) Diagnosis, treatment and outcome of Kawasaki disease in an Australian tertiary setting: a review of three years experience. J Paediatr Child Health 41(9–10):495–499
Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, Son C, Lee J (2009) Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 168(11):1315–1321
Sonobe T, Kiyosawa N, Tsuchiya K, Aso S, Imada Y, Imai Y, Yashiro M, Nakamura Y, Yanagawa H (2007) Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 49(4):421–426
Sudo D, Monobe Y, Yashiro M, Mieno MN, Uehara R, Tsuchiya K, Sonobe T, Nakamura Y (2012) Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan. Eur J Pediatr 171(4):651–656
Sudo D, Monobe Y, Yashiro M, Sadakane A, Uehara R, Nakamura Y (2010) Case–control study of giant coronary aneurysms due to Kawasaki disease: the 19th nationwide survey. Pediatr Int 52(5):790–794
Vijayan AP, Dinesh KB, Nath KR (2009) Coronary artery dilatation in incomplete Kawasaki disease. Indian Pediatr 46(7):607–609
Wilder MS, Palinkas LA, Kao AS, Bastian JF, Turner CL, Burns JC (2007) Delayed diagnosis by physicians contributes to the development of coronary artery aneurysms in children with Kawasaki syndrome. Pediatr Infect Dis J 26(3):256–260
Witt MT, Minich LL, Bohnsack JF, Young PC (1999) Kawasaki disease: more patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics 104(1):e10
Yeo Y, Kim T, Ha K, Jang G, Lee J, Lee K, Son C (2009) Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 168(2):157–162
Zhang T, Yanagawa H, Oki I, Nakamura Y, Yashiro M, Ojima T, Tanihara S (1999) Factors related to cardiac sequelae of Kawasaki disease. Eur J Pediatr 158(9):694–697
Zhang W, Li Q, Zhao XD, Tang XM, Wang XG, Wang M, Wu DQ, Ou Q, Yang XQ (2006) Clinical analysis of 942 cases of Kawasaki disease. Zhonghua Er Ke Za Zhi 44(5):324–328
This study was supported by Hin Moe fund (Dr. Hyun-Gum Lee).
Conflict of interest
We have no conflict of interest to declare.
About this article
Cite this article
Ha, K., Jang, G., Lee, J. et al. Incomplete clinical manifestation as a risk factor for coronary artery abnormalities in Kawasaki disease: a meta-analysis. Eur J Pediatr 172, 343–349 (2013). https://doi.org/10.1007/s00431-012-1891-5
- Coronary artery abnormality
- Kawasaki disease–incomplete