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Your search keyword '"Fazzio, G."' showing total 2 results
Start Over Author "Fazzio, G." Topic immunoglobulins, intravenous
2 results on '"Fazzio, G."'

1. Inability of Asian risk scoring systems to predict intravenous immunoglobulin resistance and coronary lesions in Kawasaki disease in an Italian cohort.

Author

Fabi M, Andreozzi L, Corinaldesi E, Bodnar T, Lami F, Cicero C, Tchana B, Landini C, Sprocati M, Bigucci B, Balsamo C, Sogno Valin P, Di Fazzio G, Iughetti L, Valletta E, Marchetti F, Donti A, and Lanari M

Subjects
Asian People, Child, Child, Preschool, Female, Heart Diseases diagnosis, Humans, Infant, Italy, Japan, Male, Mucocutaneous Lymph Node Syndrome complications, Retrospective Studies, Risk Assessment, Risk Factors, Sensitivity and Specificity, Taiwan, White People, Decision Support Techniques, Drug Resistance, Heart Diseases etiology, Immunoglobulins, Intravenous therapeutic use, Immunologic Factors therapeutic use, Mucocutaneous Lymph Node Syndrome drug therapy
Abstract

Since resistance to intravenous immunoglobulin (IVIG) is associated with coronary lesions (CALs) in Kawasaki disease (KD), it is crucial to identify patients at risk to protect them from coronary involvement. The available risk scores to predict IVIG resistance were developed in Asian populations in whom their effectiveness has been proven, but data on non-Asian children are limited. The aim of this study is to evaluate the ability of the Kobayashi, Egami, and Formosa risk scores to predict IVIG resistance and CALs in Italian patients with KD. A multicenter retrospective analysis involving children with KD diagnosed between 2000 and 2015 was carried out: 257 patients were enrolled (57.9% boys, 89.9% Caucasian); 43 patients were IVIG resistant (16.7%). The scores have low sensitivity and specificity in predicting IVIG resistance: respectively, KS 64% and 62.5%, ES 41.4% and 77.4%, and FS 70.8% and 44.9%. The predictive value of the 3 scores for predicting CALs was also poor.Conclusion: Kobayashi, Egami, and Formosa Scores are ineffective in predicting IVIG resistance and coronary involvement in a predominantly Caucasian cohort. A specific score system for mostly Caucasian children with KD is needed enable the early identification of those at risk for CALs who could benefit from intensified treatment. What is Known: • There are several risk scores developed in the Asian population to early identify patients with KD at risk for immunoglobulin-resistance and thus for coronary lesions. • Data are scarce on their effectiveness in non-Asian children. What is New: • We present a comprehensive analysis of the ability of 3 Asian risk scores in a cohort of mostly Caucasian children to predict immunoglobulin resistance and coronary involvement. • Low sensitivity and specificity of the Asian scores for immunoglobulin-resistance and coronary lesions suggest the need for criteria specific for different ethnicities.

Published
2019
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2. Non-coronary cardiac events, younger age, and IVIG unresponsiveness increase the risk for coronary aneurysms in Italian children with Kawasaki disease

Author

Paola Sogno Valin, Marcello Lanari, Ada Dormi, Giorgia Di Fazzio, Ilaria Frabboni, Federico Marchetti, Lorenzo Iughetti, Laura Andreozzi, Barbara Bigucci, Claudia Balsamo, Andrea Donti, Cristina Cicero, Francesca Lami, Enrico Valletta, Elena Corinaldesi, Rosa Francavilla, Monica Sprocati, Bertrand Tchana, Marianna Fabi, Fabi M., Andreozzi L., Frabboni I., Dormi A., Corinaldesi E., Lami F., Cicero C., Tchana B., Francavilla R., Sprocati M., Bigucci B., Balsamo C., Valin P.S., Di Fazzio G., Iughetti L., Valletta E., Marchetti F., Donti A., and Lanari M.

Subjects
Male, medicine.medical_specialty, Heart disease, Caucasian, Coronary aneurysms, Coronary lesions, Kawasaki disease, Non-coronary lesions, Seasonality, Mucocutaneous Lymph Node Syndrome, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Rheumatology, Internal medicine, medicine, Humans, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Risk factor, Child, Prospective cohort study, Retrospective Studies, 030203 arthritis & rheumatology, business.industry, Immunoglobulins, Intravenous, Infant, Coronary aneurysm, Non-coronary lesion, General Medicine, medicine.disease, medicine.anatomical_structure, Italy, Child, Preschool, Cohort, business, Coronary lesion, Artery
Abstract

Objectives: Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children in high-income countries because of coronary artery involvement. Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors. Methods: Multicenter retrospective and prospective study including 372 consecutive children (58% boys; mean age 34.3 ± 30.3 months, Caucasian 85%) was diagnosed with KD. We divided the cohort into 2 groups according to the presence of coronary anomalies (CAA) and aneurysms. We compared the groups and studied the risk factors for CAA and for aneurysms, the most severe lesions. Results: Children with CAA were 91/372 (24.46%, aneurysms 20/372, 5.37%). Children with CAA were more likely to have a longer duration of fever (p < 0.001), later day of treatment (p < 0.001), to be IVIG non-responders and late treated (p < 0.001), while age, clinical presentation, and seasonality were not different. They also had significantly higher WBC and neutrophils, lower lymphocytes, Hb and Na during the acute stage, and slower resolution of inflammation. Age, IVIG unresponsiveness, and presence of non-coronary cardiac findings were independent risk factors for CAA and for aneurysms, while neutrophils just for CAA. Age under 6 months was a risk factor for the aneurysm. Aneurysms occurred more frequently in the first quartile of the age of KD onset (under 14 months). Conclusion: Very young children with non-coronary cardiac findings are at increased risk for a more severe form of KD with aneurysms. These children could benefit from adjunctive therapy beside IVIG, especially if they have higher markers of inflammation, particularly neutrophils.Key points• Risk factors for coronary lesions can vary in consideration of different genetic background and environmental factors.• Risk factors for coronary involvement have been extensively studied in the Asian population, and others have been validated in cohorts with mixed ethnicities.• In our predominantly Caucasian population, non-coronary cardiac findings, age younger than 6 months, and IVIG unresponsiveness are independent risk factors for a more severe form of KD with aneurysms.

Published
2020
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