Predicting coronary artery abnormalities in Kawasaki disease: Model development and validation

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: AUC 0.79 for simple model using maximum Z score at week 1

• Primary Outcome: Coronary artery abnormalities (Z score ≥2) at one month

• Nnt Or Sensitivity: CAA incidence 5.5% (PEACOCK) and 6.8% (Post-RAISE); models failed to efficiently reduce screening

• Confidence Interval: Not specified in abstract

Clinical Application

Models showed limited clinical utility for reducing routine echocardiography screening Relevant to Australian pediatric cardiology practice; current RACGP and cardiac society guidelines recommend routine echocardiographic surveillance in Kawasaki disease Children with Kawasaki disease requiring coronary artery surveillance

Abstract

Routine echocardiography at one month after diagnosis is the current standard for screening coronary artery abnormalities (CAA), a major complication of Kawasaki disease. The study aimed to develop and validate models to predict CAA and assess whether routine echocardiography could be safely reduced in low-risk patients. Two prospective multicenter Japanese registries were utilized: PEACOCK (development/internal validation) and Post-RAISE (external validation). Variables obtained within one week of diagnosis were used to predict CAA at one month after diagnosis, defined as a maximum coronary artery Z score (Zmax) ≥ 2. The models included simple models using the previous maximum Z score only, logistic regression models, and machine learning models (LightGBM and XGBoost). Discrimination, calibration, and clinical utility were assessed. Among 4,973 PEACOCK and 2,438 Post-RAISE patients, the CAA incidence was 5.5% and 6.8%, respectively. Twenty-two models were developed using 29 variables. For external validation, a simple model using the maximum Z score at week 1 produced an area under the curve (AUC) of 0.79; adding other variables or using more complex models did not increase the AUC by more than 0.02. The models failed to efficiently reduce the number of echocardiographic examinations while minimizing missed cased of CAA.Conclusion: Until superior predictors are identified, routine echocardiography at one month after diagnosis should remain the standard practice.

References

1. 1.Wang, Q., Kimura, Y., Oba, J., Ishikawa, T., Ohnishi, T., Akahoshi, S., Iio, K., Morikawa, Y., Sakurada, K., Kobayashi, T., & Miura, M. (2026). Predicting coronary artery abnormalities in Kawasaki disease: Model development and validation. European Journal of Pediatrics. https://doi.org/10.1007/s00246-024-03762-9