ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Cardiology
A Prediction Model for Post-Treatment Presence of Coronary Artery Abnormality Before Initial Treatment in Kawasaki Disease in Japan
Provisionally accepted
Takayuki Suzuki1*
Naomi Kitano1
Nobuyuki Kakimoto1
Tomohiro Suenaga1
Shoichi Shibuta2Takashi Takeuchi3
Hiroyuki Suzuki4Kota Abe5Kumi Yasukawa5Kentaro Okunushi6
Hiromichi Hamada6
DAISUKE TOKUHARA1- 1Wakayama Medical University, Wakayama, Japan
- 2Kinan Byoin, Tanabe, Japan
- 3Kainan Iryo Center, Kainan, Japan
- 4Wakayama Tsukushi Iryo Fukushi Center, Iwade, Japan
- 5Tokyo Joshi Ika Daigaku Yachiyo Iryo Center, Yachiyo, Japan
- 6Chiba Daigaku, Chiba, Japan
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Background: This study aimed to develop and validate a predictive model for the presence of coronary artery abnormality (CAA) after treatment using pre-treatment clinical and laboratory parameters, including coronary Z-scores, in Japanese patients with Kawasaki disease (KD). Method and Results: A retrospective multicenter cohort study was conducted, analyzing 1,565 patients diagnosed with KD across eight medical institutions within the Wakayama Kawasaki Disease Clinical Research Group, with validation performed at Chiba University and Tokyo Women's Medical University. A predictive model was developed using data from a primary cohort (n = 970) and validated in both internal (n = 333) and external (n = 262) cohorts. Multivariate analysis identified three predictors of post-treatment CAA presence: maximum pre-treatment Z-score ≥1.6 (2 points), albumin level ≤3.1 g/dL (1 point), and age ≤12 months (1 point). A total score of ≥2 predicted CAA with 84.2% sensitivity and 60.8% specificity in the development cohort, with similar performance validated in the internal and external cohorts (area under the receiver operating characteristic curve: both 0.88).Conclusions: The developed model accurately predicts post-treatment CAA presence, emphasizing the importance of early coronary Z-score assessment. It could guide intensive initial therapies to reduce CAA incidence, supporting KD management. However, further validation in diverse populations is recommended.
Keywords: Coronary artery abnormality, Coronary artery Z-score, Echocardiography, kawasaki disease, predictors
Received: 15 Jun 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Suzuki, Kitano, Kakimoto, Suenaga, Shibuta, Takeuchi, Suzuki, Abe, Yasukawa, Okunushi, Hamada and TOKUHARA. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Takayuki Suzuki, tasuzuki@wakayama-med.ac.jp
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