Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children
Authors: Khoury Michael , Harahsheh Ashraf S. , Raghuveer Geetha , Dahdah Nagib , Lee Simon , Fabi Marianna , Selamet Tierney Elif Seda , Portman Michael A. , Choueiter Nadine F. , Elias Matthew , Thacker Deepika , Dallaire Frédéric , Orr William B. , Harris Tyler H. , Norozi Kambiz , Truong Dongngan T. , Khare Manaswitha , Szmuszkovicz Jacqueline R. , Pagano Joseph J. , Manlhiot Cedric , Farid Pedrom , McCrindle Brian W. ,   International Kawasaki Disease Registry, Alsalehi Mahmoud , Ballweg Jean A. , Barnes Benjamin T. , Braunlin Elizabeth , Buffone Ashley , Bustamante-Ogando Juan Carlos , Chang Arthur J. , Dancey Paul , De Ferranti Sarah D. , Dimes Catherine , Dionne Audrey , El Ganzoury Mona , El Samman Nora , Fernández Cooke Elisa , Garrido-Garcia Luis Martin , Giglia Therese M. , Goldenberg Guillermo Larios , Harris Kevin C. , Hicar Mark D. , Hidalgo Corral Nicolas M. , Jain Supriya S. , Jone Pei-Ni , Kajimoto Hidemi , Kutty Shelby , Lanari Marcello , Lowndes Robert W. , Maksymiuk Victoria , Mauriello Daniel , McHugh Kimberly E. , Merves Shae A. , Misra Nilanjana , Mohandas Sindhu , Mondal Tapas , Nowlen Todd T. , Prasad Deepa , Ravi Prasad , Sabati Arash A. , Sehgal Anupam , Shah Ashish , Sundaram Balasubramanian , Toral Vázquez Belén , Tremoulet Adriana H. , Venkataraman Aishwarya , Yamazaki-Naksahimada Marco Antonio , Yetman Anji T. , Zadokar Varsha 
Published: December 2023

Importance

Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.

Objective

To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.

Design, Setting, and Participants

In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.

Main Outcomes and Measures

Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI &amp;lt;85th percentile), overweight (BMI ≥85th to &amp;lt;95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.

Results

Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P &amp;lt; .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.

Conclusions and Relevance

In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.