Effect Of Corticosteroid On Coronary Artery Lesions In Kawasaki Disease:A Meta-Analysis

Objective:To evaluate the effect of corticosteroid therapy on coronary artery lesions（CAL）in Kawasaki disease（KD）and the safety of corticosteroid treatment,and to determine the effective course,timing,and selection of patients with KD for corticosteroid use.Method:We searched the keywords [“Kawasaki disease”] and [“corticosteroid” OR“glucocorticoids”,etc.] in databases of PubMed,Medline,Embase,the Clinical Trials.gov website,the Cochrane Library,Sino Med,CNKI,VIP Database,and Wanfang Data until January 2022,for high-quality randomized controlled studies（RCT）on the use of corticosteroid as the treatment of KD.All relevant literature was reviewed by 2 evaluators independently to determine suitability for inclusion.RevMan 5.4.1software was used to perform the Meta-analysis.Results:A total of 7 RCT were included in the meta-analysis from database research.Overall study showed that compared with intravenous immunoglobulin（IVIG）therapy,corticosteroid therapy significantly reduced the incidence of CAL（OR = 0.35,95%CI:[0.14,0.91],P = 0.03）,the rate of retreatments（OR = 0.32,95%CI: [0.15,0.72],P =0.006）and length of hospital stay（MD =-1.00 d,95%CI: [-1.72,-0.29],P = 0.006）,and there was no significant difference in the incidence of drug-related adverse events between the two groups（OR = 1.48,95%CI: [0.56,3.89],P = 0.43）.Subgroup analysis showed that longer course of corticosteroid therapy was more effective in reducing the incidence of CAL（OR = 0.13,95%CI: [0.05,0.32],P < 0.00001）.The incidence of CAL was significantly lower in the use of corticosteroid in initial treatment for KD（OR= 0.26,95%CI: [0.09,0.71],P = 0.008）.For patients predicted to be at high risk of IVIG resistance,the effect of corticosteroid therapy in reducing the incidence of CAL was more pronounced（OR = 0.12,95%CI: [0.05,0.31],P < 0.00001）.GRADEpro GDT website was used to grade evidence quality.We considered evidence was high quality for the incidence of drug-related adverse events,and length of hospital stay.We considered evidence was moderate for the incidence of CAL as subgroup analysis shows that receiving single-dose corticosteroid therapy and receiving corticosteroid as rescue therapy failed to reduce the incidence of CAL.We considered evidence was moderate for the rate of retreatments due to the large heterogeneity.Conclusion:（1）Corticosteroid therapy can safely and effectively reduce the risk of CAL in children with KD.（2）During the acute phase of KD,it is recommended to use a long course of corticosteroid therapy to treat KD as soon as possible.（3）KD Patients with a high risk of resistance to IVIG may benefit the most from corticosteroid therapy.