Risk factors and performance of coronary aneurysm risk scores in children with Kawasaki disease.

Purpose: Kawasaki disease (KD) is the leading cause of acquired heart disease in children, and coronary artery aneurysm (CAA) remains its most serious complication. Several clinical risk scoring systems have been developed to predict coronary involvement, mainly in East Asian populations, but their performance varies across different settings. This study aimed to identify clinical predictors of CAA and to evaluate the performance of commonly used risk scoring systems in a Turkish pediatric cohort. Methods: This retrospective single-center study included children diagnosed with KD between 1994 and 2019 in tertiary reference center of Türkiye. Demographic, clinical, and laboratory data were analyzed. CAA was defined as a coronary artery z-score ≥2.5. Established risk scoring systems were evaluated for their ability to identify patients with CAA. Results: Eighty-one patients were included, and CAA developed in 18 (22.2%). Younger age at diagnosis, prolonged fever duration, and delayed intravenous immunoglobulin (IVIG) treatment were more frequently observed among patients with CAA. Commonly used risk scores showed low sensitivity and limited overall performance in identifying patients with coronary involvement in this cohort. Conclusions: In this Turkish pediatric cohort, established Kawasaki disease risk scoring systems demonstrated variable diagnostic performance for predicting coronary artery aneurysm, with no single scoring system providing consistently balanced sensitivity and specificity. Age at diagnosis, fever duration, and timing of IVIG treatment may provide useful clinical indicators during patient assessment.