Correlation between Mycoplasma Pneumoniae Infection and Coronary Artery Lesions in Mucocutaneous Lymph Node Syndrome: a Meta-analysis

Abstract

Background The incidence of mucocutaneous lymph node syndrome (MCLS), also known as Kawasaki disease (KD), has been increasing year by year. Coronary artery lesions (CAL) induced by KD has become the main cause of acquired heart disease in children. Many clinical studies show that mycoplasma pneumoniae (MP) is associated with CAL in KD, but the strength of association between them differs across original research on different individuals. Objective To systematically evaluate the correlation between MP infection and CAL in KD, providing evidence for early and timely delivery of effective clinical treatment to improve the quality of life and to prevent adverse outcomes in children with KD. Methods Observational studies on KD〔KD patients with MP infection (MP-IgM positive) (exposed group) compared with those with simple KD (control group), with CAL as the outcome measure〕 were retrieved from databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science from inception to April 3, 2022. Two researchers independently performed literature screening and data exaction. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Stata 15.0 and RevMan 5.4 were used for data analysis. Results A total of 31 studies involving 6 131 subjects were included. The average quality score of the studies rated using the NOS was 7, indicating a high overall quality. Meta-analysis showed that the risk of CAL in the exposed group was higher than that in the control group〔RR=1.65, 95%CI (1.40, 1.94), P<0.000 01〕. Subgroup analysis based on baseline data revealed that, the risk of CAL in exposed group was higher in studies on exposed and control groups with matched baseline data〔RR=1.92, 95%CI (1.71, 2.16), P<0.000 01〕, but was similar in studies on two groups with unmatched baseline data〔RR=0.98, 95%CI (0.91, 1.06), P=0.65〕. Furthermore, the risk of CAL was found to be higher in the exposed group in subgroup analysis based on MP infection diagnosed serologically with IgM>1∶160, or by quantitative PCR, or undescribed method (P<0.05). And in subgroup analysis based on age, C-creactive protein/procalcitonin ratio, or undescribed method, the risk of CAL was still higher in the exposed group (P<0.05). Egger's and Begg's tests showed that all the studies had publication bias (P<0.05). However, the comparison of the pooled effect size using the random effects model〔RR=1.32, 95%CI (1.13, 1.54), P<0.000 01〕 showed that the results before and after trimming and filling were not reversed, indicating that the results of this study were relatively stable. Conclusion MP infection increased the risk of CAL in children with KD. Early detection of MP and timely delivery of effective intervention are very important.

Keywords

• mucocutaneous lymph node syndrome|kawasaki disease|mycoplasma pneumoniae|coronary artery lesions|meta-analysis