Meta-analysis Of Risk Factors For Coronary Artery Disease Complicated By Kawasaki Disease

Background and PurposeKawasaki disease with coronary artery lesions has become a major cause of children acquired heart disease in developed areas of the world.Children with coronary artery lesions are at risk for coronary thrombosis,myocardial infarction,and sudden death.To understand the clinical characteristics of children with coronary artery lesions can adopt more active methods in the treatment to reduce the incidence of coronary artery lesions.Some children may have coronary artery disease in the future,closer follow-up can be conducted to timely detect coronary artery lesions,and early intervention can improve the prognosis.In this paper,the risk factors of Kawasaki disease complicated with coronary artery lesions were analyzed by meta-analysis,so as to find accurate predictors and provide early diagnosis basis for reducing coronary artery lesions.MethodsSearch CNKI,Wanfang Database,cpvip,Sino Med,Embase,Pubmed,Cochrane Library,Web of science 8 databases published on risk factors of Kawasaki disease complicated with coronary arteries lesions.According to the thesaurus of different databases,the search method of subject words and free words is adopted.According to the inclusion and exclusion criteria,End Note X7 was used for screening,and the NOS scale was used to conduct a bias risk assessment to determine the final included paper.Extract the data in the paper,including the statistically significant OR value and 95%CI obtained from Logistic regression analysis of categorical variables,or the number of CAL and n CAL groups,the OR value and 95%CI calculated from the two groups of people is adopted.Continuous variables were extracted from the two groups of people,means,and standard deviations.The Q test and I~2test were used to analyze the heterogeneity of the included data,and the data that had a greater impact on heterogeneity were deleted.Based on the heterogeneity after deletion,a fixed effect model or a random effect model was selected to run meta-analysis by Rev Man5.3software.Sensitivity analysis of the results was performed by deleting or re-incorporating the paper.Using STATA14.0 software,the Eggger linear regression and Begg rank correlation were used to test the publication bias,if there is a publication bias,the effect of the bias was analyzed using the trim and fill method.ResultsA total of 1081 papers were retrieved from 8 databases.Nineteen papers were included in the meta-analysis,with a total of 12,989 cases,including 2944 cases with CAL and 10045 cases of n CAL.Evaluate these papers by NOS scale,11 articles 6points,7 articles 7 points,1 article 8 points.Involved indicators include:male,intravenous immunoglobulin resistance,age<1 year,age>5 years,intravenous immunoglobulin 10 days after onset,intravenous immunoglobulin within 5 days of onset,incomplete Kawasaki disease,white blood cell count,Percentage of neutrophils,hemoglobin,platelet count,hematocrit,erythrocyte sedimentation rate,C-reactive protein,albumin,sodium.Heterogeneity analysis results showed that intravenous immunoglobulin within 5 days of onset and C-reactive protein were more heterogeneous,and meta-analysis was abandoned.male,age>5 years old,intravenous immunoglobulin 10 days after onset,neutrophil percentage,hemoglobin,hematocrit,erythrocyte sedimentation rate,serum sodium were analyzed using a fixed effect model,and the remaining indicators were selected as random effect model.The analysis results showed that the male,OR value is 1.66,the 95%CI is from 1.47 to1.87,and P<0.05,the difference was statistically significant.The sensitivity analysis and publication bias test showed that the research results were stable;the OR value of the intravenous immunoglobulin resistance is 3.09,95%CI is 2.01～4.75,P<0.05,the difference was statistically significant.Sensitivity analysis and publication bias test showed that the study results were stable;OR value was 1.81 for age<1 year,95%CI is 1.24～2.65,P<0.05,the difference is statistically significant.Sensitivity analysis and publication bias test show that the research results are stable;age>5years old OR value is 0.40,95%CI is 0.28～0.57,P<0.05,the difference is statistically significant,sensitive Sex analysis and publication bias test showed that the research results were stable and reliable.The OR value of intravenous immunoglobulin 10 days after onset is 4.36,95%CI is 3.59～5.30,P<0.05.The difference was statistically significant.The sensitivity analysis and publication bias test showed that the study results were stable;the incomplete Kawasaki disease OR value is 1.49,the 95%CI is 1.16～1.92,P<0.05,and the difference was statistically significant.The sensitivity analysis and publication bias test showed that the results were stable;the white blood cell count WMD is 2.02,95%CI is 1.14～2.90,P<0.05,the difference is statistically significant.Analysis of publication bias shows that the study may have publication bias,and the results are not stable.The neutrophil percentage WMD is-0.69,95%CI is-2.00～0.61,P>0.05,the difference No statistical significance,sensitivity analysis and publication bias test showed stable results;hemoglobin WMD is-2.87,95%CI is-3.62～-2.12,P<0.05,the difference was statistically significant,sensitivity analysis and publication bias test showed The research results are stable;the hematocrit WMD is-0.79,and the 95%CI is-1.17～-0.40,P<0.05,the difference is statistically significant.Sensitivity analysis and publication bias tests show that the research results are stable and reliable;the platelet count WMD is 60.69,95%CI is 37.65～83.72,P<0.05,the difference is statistically significant.Sensitivity analysis and publication bias test show that the research results are stable;albumin WMD is-1.10,95%CI is-1.75～-0.46,P<0.05,the difference is statistically significant.Sensitivity analysis and publication bias test show that the research results are stable and reliable;the red blood cell sedimentation rate WMD is2.05,95%CI is-0.36～4.45,P>0.05,the difference is not statistically significant,sensitivity The analysis showed that the results were unstable;sodium WMD is 0.13,95%CI is-0.17～0.43,and P>0.05.The difference was not statistically significant.Sensitivity analysis and publication bias tests showed that the results were stable and reliable.ConclusionsMale,intravenous immunoglobulin resistance,age<1year,intravenous immunoglobulin 10 days after onset,incomplete Kawasaki disease are risk factors for coronary artery lesions,and age>5 years are protective factors for coronary artery lesions.In children with coronary artery lesions,the baseline of platelet count is higher than in children without coronary artery lesions,and the baseline values of hemoglobin,albumin,and hematocrit are lower than those.The results of percentage of neutrophils and sodium showed no difference.