Predictive Value Of Red Cell Distribution Width For Coronary Artery Lesions In Patient With Kawasaki Disease

Background and purpose:Kawasaki disease (KD) is an acute multisystemic vasculitis of unknown etiology that occurs in infants and children, it primarily affects small and medium-sized arteries, especially coronary artery. And coronary arterial lesions (CALs) seriously affects patients’ prognosis. Recent studies have reported that higher red blood cell distribution width(RDW) is an independent predictor of mortality and poor prognosis in patients with cardiovascular and other diseases, even after adjustment for other factors. The purpose of our study is to assess the predictive value of red cell distribution width (RDW) for coronary artery lesions (CALs) in patient with Kawasaki Disease (KD).Materials and Methods:Between August 2009 and December 2012,422 patients with KD were enrolled in this study at the Children’s Hospital, Zhejiang University School of Medicine. Patients were divided into 2 groups:CALs group and NCALs group according to their Echocardiographic examination, to find if there was significant difference with RDW between the two groups. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting CALs was 14.55%. Then the patients were divided into two groups:higher RDW group (RDW>14.55%) and lower RDW group (RDW<14.55%), clinical, echocardiographic and biological variables were evaluated in the two groups, to determine the variables independently associated with RDW levels. At last, we use Logistic regression analysis to find the independent predictors of CALs in patient with KD. All statistical analyses were performed using SPSS software version 16.0. A P value of 0.05 was considered statistically significant.Results:Four hundred and twenty-two consecutive patients with KD were enrolled. And eighty-three patients (19.7%) have CALs, while three hundred and thirty-three without CALs. There was significant difference in RDW(P<0.01), the level of RDW was much more higher in CALs group than NCALs group. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting CALs was 14.55%(area under the curve was 0.721; P=0.000).70% of patients with CALs had RDW level>14.55%.Logistic regression analysis revealed that fever duration> 14 days (odds radio [OR] was 3.42,95% confidence interval [CI] was 1.27-9.22; P=0.015), IVIG resistance (OR was 2.33,95% CI was 1.02-5.29; P=0.04) and RDW>14.55% (OR was 3.49,95% CI was 2.01-6.05;P=0.000) were independent predictors of CALs in patients with KD.Conclusion:1. RDW was a valuable factor for predicting CALs in patients with Kawasaki disease, and the morbidity of CALs is high in patients with high levels of RDW values.2. Fever duration> 14 days、IVIG resistance and RDW>14.55%were independent predictors of CALs in patients with KD.