Comparison of Clinical Manifestations of Kawasaki Disease According to SARS-CoV-2 Antibody Positivity

Background: Kawasaki disease (KD) is the most common cause of acquired heart disease in paediatric patients, with infectious agents being the main cause. This study aimed to determine whether there are differences in the clinical manifestations of KD between patients with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies.

Methods: From January 1, 2021 to August 15, 2022, 82 patients with analysable echocardiographic data were diagnosed with KD. Twelve patients with multisystem inflammatory syndrome in children were excluded. Serologic tests were performed by chemiluminescence immunoassay for both the nucleocapsid (N) and the spike (S) proteins in blood samples. Among the 70 patients diagnosed with KD at Jeonbuk University Children's Hospital, the SARS-CoV-2 antibody test was performed in 41 patients.

Results: The SARS-CoV-2 antibody test results for the N antigen were positive in 12 patients, while those for S protein were positive in 14 patients. N antigen SARS-CoV-2 antibody-positive KD was different from N antigen SARS-CoV-2 antibody-negative KD in terms of sex (male predominance in the positive group, 83.3% vs. female predominance in the negative group 62.1%, P = 0.008) and the incidence of refractory KD (41.7% vs. 10.3%, P = 0.034). The pro-B-type natriuretic peptide level was lower in the N-antigen SARS-CoV-2 antibody-positive KD group than that in the negative group (518.9 ± 382.6, 1,467.0 ± 2,417.6, P = 0.049). No significant differences in the echocardiographic findings between both groups were noted. In the multi-variable analysis, SARS-CoV-2 antibody (N antigen) was the only predictor of refractory KD (odds ratio, 13.70; 95% confidence interval, 1.63-115.44; P = 0.016).

Conclusion: High incidence of intravenous immunoglobulin-refractory KD may occur in up to 40% of the patients having recent history of coronavirus disease 2019. For patients having KD with N-type SARS-CoV-2 antibody positivity, adjunctive treatment, such as corticosteroids, can be considered as the first line of treatment.