title: Coronary Artery Complication in Kawasaki Disease and the Importance of Early Intervention : A Systematic Review and Meta-analysis.
abstract: The timing and selection of patients with Kawasaki disease for corticosteroid use to prevent coronary artery complications remain controversial.
  
  
  
  To evaluate the effect of corticosteroid therapy in KD.
  
  
  
  Databases of Medline, The Cochrane Library, and the Clinicaltrials.gov website until July 2015. We used the key words ["Kawasaki disease"] and ["steroid" OR "corticosteroid"] to retrieve potentially relevant studies in the databases of Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2015. Both English and non-English literature was identified. Titles and abstracts were reviewed by 2 authors (S.C. and Y.D.) to determine suitability for inclusion. Relevant articles were reassessed by reviewing the full text. Discrepancies in study inclusion were resolved by consensus (M.G.K.).
  
  
  
  Clinical studies that compared corticosteroids plus intravenous immunoglobulin (IVIG) therapy with IVIG therapy alone in treating patients with KD. Studies either using corticosteroids as initial therapy or as rescue therapy were included.
  
  
  
  Investigators independently extracted the data information. Data were quantitatively synthesized using random-effects analysis.
  
  
  
  Rate of coronary artery abnormalities.
  
  
  
  Sixteen comparative studies characterizing 2746 patients were analyzed. The duration of illness before corticosteroids therapy was significantly shorter in the initial corticosteroids subset than in the rescue corticosteroids subset. The rate of coronary artery abnormalities was significantly lower in adjunctive corticosteroids therapy than in IVIG therapy (odds ratio [OR], 0.424; 95% CI, 0.270-0.665). Meta-regression based on known variables demonstrated that the overall efficacy was negatively correlated with the duration of illness before corticosteroid therapy (P < .001). Subgroup analysis, including studies using corticosteroids plus IVIG as initial therapy, showed a more advantageous effect than IVIG alone regarding coronary artery abnormality prevention (OR, 0.320; 95% CI, 0.183-0.560), whereas this benefit was not found in a subgroup of studies using corticosteroids as rescue therapy. Further analysis found that patients predicted at baseline to be at high risk of IVIG resistance seemed to obtain the greatest benefit from adjunctive corticosteroid therapy regarding coronary artery abnormality prevention (OR, 0.240; 95% CI, 0.123-0.467). The fever duration was significantly reduced in the corticosteroids group. The favorable effects of corticosteroids were conferred without an increased risk of adverse events.
  
  
  
  This study highlights the importance of timing to prevent coronary artery complication in treating KD. High-risk patients with KD benefit greatly from a timely and potent adjunctive corticosteroid therapy strategy.
authors.affiliation: Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China2Allgemein öffentliches Krankenhaus Elisabethinen Linz and Department of Cardiology, Elisabethinen University Teaching Hospital of Medical University Innsbruck and Vienna, Linz, Oberösterreich, Austria.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Hospital e Clínica São Gonçalo, Department of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil.
authors.forename: Marcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.affiliation: Humanmedzin, Universität Leipzig, Leipzig University, Freistaat Sachsen, Germany.
authors.forename: Jiazhi
authors.initials: J
authors.lastname: Wang
authors.affiliation: Herzzentrum Universität Leipzig, Heart Center Leipzig University, Leipzig, Freistaat Sachsen, Germany.
authors.forename: Ruotian
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Cardiology, Second Affiliated Hospital Chongqing Medical University, Chongqing, China.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Ling
authors.affiliation: Department of Cardiology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Tingquan
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Department of Cardiology, Affiliated Hospital of Zunyi Medical College, Zunyi, China.
authors.forename: Zhenglong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Allgemein öffentliches Krankenhaus Elisabethinen Linz and Department of Cardiology, Elisabethinen University Teaching Hospital of Medical University Innsbruck and Vienna, Linz, Oberösterreich, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Martinek
authors.affiliation: Allgemein öffentliches Krankenhaus Elisabethinen Linz and Department of Cardiology, Elisabethinen University Teaching Hospital of Medical University Innsbruck and Vienna, Linz, Oberösterreich, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Pürerfellner
authors.affiliation: Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shaowen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Medicine and Cardiology, Duke University Medical Center, Durham, North Carolina11Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous