The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness
Objective: 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. Metho...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-06-01
|
| Series: | Journal of Microbiology, Immunology and Infection |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118217301950 |
| _version_ | 1811331675756429312 |
|---|---|
| author | Tsung-Ju Yang Ming-Tai Lin Chun-Yi Lu Jong-Min Chen Ping-Ing Lee Li-Min Huang Mei-Hwan Wu Luan-Yin Chang |
| author_facet | Tsung-Ju Yang Ming-Tai Lin Chun-Yi Lu Jong-Min Chen Ping-Ing Lee Li-Min Huang Mei-Hwan Wu Luan-Yin Chang |
| author_sort | Tsung-Ju Yang |
| collection | DOAJ |
| description | Objective: 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).
Conclusions: We demonstrated an overall reduction in incidence of coronary artery lesions with the use of corticosteroid as initial and adjuvant treatment for Kawasaki disease. |
| first_indexed | 2024-04-13T16:24:14Z |
| format | Article |
| id | doaj.art-dc166585fff540b68ffc17d5dc77fbcc |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-04-13T16:24:14Z |
| publishDate | 2018-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-dc166585fff540b68ffc17d5dc77fbcc2022-12-22T02:39:47ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822018-06-0151332133110.1016/j.jmii.2017.08.012The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectivenessTsung-Ju YangMing-Tai LinChun-Yi LuJong-Min ChenPing-Ing LeeLi-Min HuangMei-Hwan WuLuan-Yin ChangObjective: 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). Conclusions: We demonstrated an overall reduction in incidence of coronary artery lesions with the use of corticosteroid as initial and adjuvant treatment for Kawasaki disease.http://www.sciencedirect.com/science/article/pii/S1684118217301950Kawasaki diseaseCorticosteroidCoronary artery aneurysmsCoronary artery lesionsAcquired heart disease in children |
| spellingShingle | Tsung-Ju Yang Ming-Tai Lin Chun-Yi Lu Jong-Min Chen Ping-Ing Lee Li-Min Huang Mei-Hwan Wu Luan-Yin Chang The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness Journal of Microbiology, Immunology and Infection Kawasaki disease Corticosteroid Coronary artery aneurysms Coronary artery lesions Acquired heart disease in children |
| title | The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness |
| title_full | The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness |
| title_fullStr | The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness |
| title_full_unstemmed | The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness |
| title_short | The prevention of coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid effectiveness |
| title_sort | prevention of coronary arterial abnormalities in kawasaki disease a meta analysis of the corticosteroid effectiveness |
| topic | Kawasaki disease Corticosteroid Coronary artery aneurysms Coronary artery lesions Acquired heart disease in children |
| url | http://www.sciencedirect.com/science/article/pii/S1684118217301950 |
| work_keys_str_mv | AT tsungjuyang thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT mingtailin thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT chunyilu thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT jongminchen thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT pinginglee thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT liminhuang thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT meihwanwu thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT luanyinchang thepreventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT tsungjuyang preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT mingtailin preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT chunyilu preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT jongminchen preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT pinginglee preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT liminhuang preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT meihwanwu preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness AT luanyinchang preventionofcoronaryarterialabnormalitiesinkawasakidiseaseametaanalysisofthecorticosteroideffectiveness |