The changes of coagulation profiles in Kawasaki disease and its associations with clinical classification, intravenous immunoglobulin responsiveness and coronary artery involvement.

Coagulation disorders are common in Kawasaki disease (KD). The main objectives of the present study were to probe the associations of coagulation profiles with clinical classification, IVIG responsiveness, coronary artery abnormalities (CAAs) in the acute episode of KD. A total of 313 KD children were recruited and divided into six subgroups, including complete KD (n = 217), incomplete KD (n = 96), IVIG-responsive KD (n = 293), IVIG-nonresponsive KD (n = 20), coronary artery noninvolvement KD (n = 284) and coronary artery involvement KD (n = 29). Blood samples were collected within 24-h pre-IVIG therapy and 48-h post-IVIG therapy. Coagulation profiles, conventional inflammatory mediators and blood cell counts were detected. Echocardiography was performed during the period from 2- to 14-day post-IVIG infusion. In addition, 315 sex- and age-matched healthy children were enrolled as the controls. (1) Before IVIG therapy, coagulation disorders were more prone to appear in KD patients than in healthy controls, and could be overcome by IVIG therapy. FIB and DD significantly increased in the acute phase of KD, whereas reduced to normal levels after IVIG therapy. (2) PT and APTT were significantly longer in patients with complete KD when compared with their incomplete counterparts after IVIG therapy. (3) The larger δDD, δFDP and the smaller δPT, δINR predicted IVIG nonresponsiveness. (4) The higher δDD and δFDP correlated with a higher risk for CAAs (DD: r = -0.72, FDP: r = -0.54). Coagulation disorders are correlated with complete phenotype, IVIG nonresponsiveness and CAA occurrence in the acute episode of KD, and can be rectified by synergistic effects of IVIG and aspirin.

The protective effects of pediatric vaccination on multisystem inflammatory syndrome in children stratified by vaccine status, types and virus variants.

BACKGROUND: Few studies highlight the stratification of COVID-19 vaccine effectiveness on MIS-C according to vaccine status, types and SARS-COV-2 variants. METHODS: A web-based analysis was conducted through searches of PubMed, Web of Science and Medline databases from January 1, 2020, to May 16, 2023. The search terms used were (multisystem inflammatory syndrome in children OR MIS-C OR PIMS OR PIMS-TS) AND (COVID-19 OR SARS-CoV-2) AND (vaccine OR vaccination) AND (children OR adolescents OR pediatric). RESULTS: 6701 children from 13 studies met the MIS-C definition. 92.1 % (1332/1446) of MIS-C cases were unvaccinated, whereas partial vaccination and full vaccination were 3.7 % (54/1446) and 4.2 % (60/1446)respectively. In the two studies encompassing 41 vaccinated MIS-C cases, 34 (82.9 %) received BNT162b2, 2 (4.9 %) received mRNA-1273, 4 (9.8 %) received Sinovac vaccine, and only one received a heterologous primary-boost regimen. Among 838 vaccinated MIS-C cases with different SARS-COV-2 variants, 23（2.8 %） were infected by the Wild-type, 80（9.5 %） by the Alpha variant, 521（62.2 %） by the Delta variant, and 214（25.5 %） by the Omicron variant. A significant difference was observed in vaccination rates among MIS-C cases across different variant pandemics (χ2 = 37.79, P < 0.001). The highest vaccination rate (26.3 %) occurred in the Alpha predominant period, thereafter dropped to 5.0 % in the Delta predominant period, and then increased to 12.6 % in the Omicron predominant period. CONCLUSIONS: Heterologous vaccination might provide a slightly more protective effect than homologous manner for MIS-C. As the virus mutates over time, its pathogenicity to MIS-C degrades among vaccinated individuals.