Kawasaki Disease-Related Mortality in Arab Countries: A Multinational Physician Survey from the Kawasaki Disease Arab Initiative (Kawarabi).

Kawasaki disease (KD) carries a favorable prognosis with timely diagnosis and treatment, yet fatal events still occur. Data on KD-related mortality in Arab countries and how patterns may have shifted since COVID-19 are unreported. We aimed to describe clinician-recalled KD-related deaths in Arab countries before and after the COVID-19 pandemic and to characterize the timing and reasons of death. The survey invited participation from all clinicians within the collaborating centers, allowing inclusion of respondents both with and without experience managing KD-related fatalities. The Kawasaki disease Arab initiative (KAWARABI) conducted a cross-sectional descriptive survey to assess the extent and circumstances of KD-related mortality across Arab countries. The survey was distributed to KAWARABI institutions and covered the period from 1990 to 2024. Seventeen clinicians from eight Arab countries completed the survey. One-third reported KD-related deaths before the pandemic and more than half did afterwards. Across both pre- and post-COVID periods, reported deaths most commonly occurred during acute disease hospitalization or within the first three months following initial KD diagnosis. Reported patterns of death reflected distinct clinical contexts in both periods. Year-by-year responses suggested a peak in (2020–2021) with a regressive trend from 2022. Most respondents indicated that autopsy is performed only when legally mandated. KD related mortality in Arab countries is rare but appeared higher during the COVID-19 pandemic. This increase may reflect diagnostic overlap between KD and MIS-C, as well as limited availability of advanced cardiac life support therapies in some Arab countries. Strengthening regional collaboration, developing prospective registries, and enhancing knowledge-sharing may help improve KD care pathways.