Kawasaki disease in the pre- and post-COVID-19 era: shifts in patterns and outcomes from a multi-center study

Purpose: Kawasaki disease (KD) is an acute vasculitis of childhood, with potential complications such as coronary artery aneurysms (CAAs). The COVID-19 pandemic introduced challenges in KD diagnosis and management due to its overlap with multisystem inflammatory syndrome in children (MIS-C). This study aims to compare the clinical presentation, laboratory findings, treatment approaches, and outcomes of KD before and after the COVID-19 pandemic across four centers in the United Arab Emirates (UAE). Methods: This retrospective study analyzed pediatric KD cases (classified per the American Heart Association “AHA” criteria) from four tertiary hospitals in the UAE. Patients were categorized into group 1 (pre-COVID-19: January 2017–January 2020) and group 2 (post-COVID-19: February 2020–January 2023). Patients not meeting the AHA criteria and those with MIS-C were excluded. Data collection included demographics, clinical and laboratory features, and echocardiograms, with coronary artery abnormalities assessed per AHA guidelines. Results: Among 138 included patients (67 in group 1, 71 in group 2), incomplete KD was significantly more common post-COVID-19 (45% vs. 25%, p = 0.020). Lower occurrence of cervical lymphadenopathy (72% vs. 50%, p = 0.009) and strawberry tongue (90% vs. 70%, p = 0.006) were noted. Compared to group 1, group 2 had higher use of steroids (40.8% vs. 12.5%, p = < 0.001) and biologics (8% vs. 1.5%, p = 0.502). Although not statistically significant, CAAs were more frequent in group 2 (21% vs. 10%, p = 0.139), with trends toward increased giant CAAs. Conclusions: Our study highlights shifts in the patterns of KD in the post-COVID-19 era. We observed a higher prevalence of incomplete KD cases over the 3 years following the pandemic. (Table presented.)