Atlantoaxial rotatory fixation in Kawasaki disease tied to older age, heavy weight

Patients with acute Kawasaki disease (KD) may develop a rare complication called atlantoaxial rotatory fixation (AARF), which must be taken into account if cervical symptoms present in older patients with atypical KD, suggests a study.

A team of investigators identified KD patients who received intravenous immunoglobulin (IVIG) treatment between July 2010 and March 2020 using the Diagnosis Procedure Combination database. They assessed the clinical characteristics and risk factors of the participants with AARF using multivariable logistic regression analysis. In addition, the association between AARF, the proportion of coronary artery abnormalities (CAAs), IVIG resistance, length of stay, and medical costs was analysed.

Of the 71,913 patients with KD identified, 166 had AARF. Those with AARF were older, heavier, and had atypical KD.

Multivariable analysis confirmed the association of AARF with older age (odds ratio [OR], 1.24, 95 percent confidence interval [CI], 1.19‒1.29), lower body mass index (OR, 0.89, 95 percent CI, 0.82‒0.96), and atypical KD (OR, 1.95, 95 percent CI, 1.12‒3.40). AARF did not correlate with CAAs (OR, 0.73, 95 percent CI, 0.23‒2.32) and IVIG resistance (OR, 1.05, 95 percent CI, 0.74‒1.49).

On the other hand, AARF contributed to higher medical costs (difference, $1,064, 95 percent CI, 346‒1,781) and longer hospital stay (difference, 3.1 days, 95 percent CI, 1.7‒4.4).

“Early diagnosis and intervention are important for AARF because delayed diagnoses may incur neurological sequelae,” the investigators said. “However, previous studies on AARF associated with KD are limited, and its clinical characteristics and course are unknown.”