{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:08:05Z","timestamp":1783940885040,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":193,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Whether prior coronavirus disease 2019 (COVID\u201019) independently influences treatment response in children with Kawasaki disease (KD) is unclear, as prior reports may have been confounded by overlap with multisystem inflammatory syndrome in children (MIS\u2010C). We investigated this in a nationwide cohort, accounting for these factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Korean National Health Insurance Service database. Children diagnosed with KD on or after January 1, 2020 who received IVIG within 7\u2009days were included. Prior COVID\u201019 was defined as documented infection within 3\u2009months before KD diagnosis. The primary outcome was second\u2010line treatment within 7\u2009days after initial IVIG (composite of second IVIG or additional steroid). 1:1 propensity score matching was performed using age, sex, MIS\u2010C status, and steroid use with initial IVIG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6572 eligible children, 512 had prior COVID\u201019; 431 patients were matched per group. Second\u2010line treatment occurred in 32\/431 (7.4%) versus 23\/431 (5.3%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.265). Prior COVID\u201019 was not independently associated with second\u2010line treatment (adjusted HR 1.42; 95% CI 0.83\u20132.43). In subgroup analysis, elevated risk was confined to children with concurrent MIS\u2010C (HR 3.01; 95% CI 1.34\u20136.74); prior COVID\u201019 without MIS\u2010C showed no increase (HR 1.18; 95% CI 0.66\u20132.11). Sensitivity analyses excluding MIS\u2010C and restricted to 2022 onward were consistent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prior COVID\u201019 alone was not independently associated with second\u2010line treatment once MIS\u2010C overlap and concurrent steroid use were accounted for. The elevated treatment escalation rate appeared driven primarily by MIS\u2010C, highlighting the importance of distinguishing MIS\u2010C from classic KD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70476","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:51:49Z","timestamp":1783939909000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>MIS<\/scp>\n                    \u2010C Overlap, Not Prior\n                    <scp>COVID<\/scp>\n                    \u201019 Itself, Drives Treatment Escalation in Kawasaki Disease: A Nationwide Cohort Study"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9774-4239","authenticated-orcid":false,"given":"Min Ji","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Medical Informatics Jeonbuk National University Medical School  Jeonju Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1384-6799","authenticated-orcid":false,"given":"Jong Seung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Jeonbuk National University Hospital  Jeonju Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-0780","authenticated-orcid":false,"given":"Jee Young","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, College of Medicine Jeonbuk National University  Jeonju Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5172-1690","authenticated-orcid":false,"given":"Jihye","family":"You","sequence":"additional","affiliation":[{"name":"Research Institute of Clinical Medicine of Jeonbuk National University  Jeonju Korea"},{"name":"Department of Pediatrics Jeonbuk National University Children's Hospital  Jeonju Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"365","article-title":"Diagnosis and Management of Kawasaki Disease","volume":"91","author":"Saguil A.","year":"2015","journal-title":"American Family Physician"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"e927","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, Treatment, and Long\u2010Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association","volume":"135","author":"McCrindle B. W.","year":"2017","journal-title":"Circulation"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1016\/j.jacc.2015.12.073","article-title":"Kawasaki Disease","volume":"67","author":"Newburger J. W.","year":"2016","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/1756-185X.13213","article-title":"Is Kawasaki Disease an Infectious Disorder?","volume":"21","author":"Rowley A. H.","year":"2018","journal-title":"International Journal of Rheumatic Diseases"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.mehy.2006.12.051","article-title":"Kawasaki Disease May Be a Hyperimmune Reaction of Genetically Susceptible Children to Variants of Normal Environmental Flora","volume":"69","author":"Lee K. Y.","year":"2007","journal-title":"Medical Hypotheses"},{"key":"e_1_2_11_7_1","first-page":"41","article-title":"Guidelines for Medical Treatment of Acute Kawasaki Disease (2020 Revised Version)","volume":"5","author":"Miura M.","year":"2021","journal-title":"Journal of Pediatric Cardiology and Cardiac Surgery"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.rdc.2023.03.002","article-title":"Kawasaki Disease and Multisystem Inflammatory Syndrome in Children: Common Inflammatory Pathways of Two Distinct Diseases","volume":"49","author":"Noval Rivas M.","year":"2023","journal-title":"Rheumatic Diseases Clinics of North America"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1038\/s41390-022-02263-w","article-title":"Multisystem Inflammatory Syndrome in Children (MIS\u2010C) and Neonates (MIS\u2010N) Associated With COVID\u201019: Optimizing Definition and Management","volume":"93","author":"Molloy E. J.","year":"2023","journal-title":"Pediatric Research"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"2687","DOI":"10.1038\/s41467-022-30357-w","article-title":"An Artificial Intelligence\u2010Guided Signature Reveals the Shared Host Immune Response in MIS\u2010C and Kawasaki Disease","volume":"13","author":"Ghosh P.","year":"2022","journal-title":"Nature Communications"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s10067-022-06444-0","article-title":"How Multisystem Inflammatory Syndrome in Children Discriminated From Kawasaki Disease: A Differentiating Score Based on an Inception Cohort Study","volume":"42","author":"Sobh A.","year":"2023","journal-title":"Clinical Rheumatology"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2023.1088529","article-title":"Clinical Characteristics and Short\u2010Term Outcomes of Multisystem Inflammatory Syndrome in a Country With a High Prevalence of KD","volume":"11","author":"You S. D.","year":"2023","journal-title":"Frontiers in Pediatrics"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1186\/s12889-024-19655-8","article-title":"Toward Better Pandemic Governance and Preparedness: South Korea's Whole\u2010Of\u2010Nation Approach to COVID\u201019","volume":"24","author":"Hong S. 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I.","year":"2022","journal-title":"Risk Management and Healthcare Policy"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4082\/kjfm.20.0062","article-title":"Conducting and Reporting a Clinical Research Using Korean Healthcare Claims Database","volume":"41","author":"Kim S.","year":"2020","journal-title":"Korean Journal of Family Medicine"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.24171\/j.phrp.2023.0026","article-title":"A Framework for Nationwide COVID\u201019 Vaccine Safety Research in the Republic of Korea: The COVID\u201019 Vaccine Safety Research Committee","volume":"14","author":"Jeong N.\u2010Y.","year":"2023","journal-title":"Osong Public Health and Research Perspectives"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2025.40.e10","article-title":"Risk of Kawasaki Disease\/Multisystem Inflammatory Syndrome Following COVID\u201019 Vaccination in Korean Children: A Self\u2010Controlled Case Series Study","volume":"40","author":"Kim S.","year":"2025","journal-title":"Journal of Korean Medical Science"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jpeds.2020.06.057","article-title":"Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses With Overlapping Clinical Features","volume":"224","author":"Rowley A. H.","year":"2020","journal-title":"Journal of Pediatrics"},{"key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.cjca.2023.06.001","article-title":"Kawasaki Disease in the Time of COVID\u201019 and MIS\u2010C: The International Kawasaki Disease Registry","volume":"40","author":"Harahsheh A. S.","year":"2024","journal-title":"Canadian Journal of Cardiology"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1038\/s41584-021-00709-9","article-title":"Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: A Critical Comparison","volume":"17","author":"Sharma C.","year":"2021","journal-title":"Nature Reviews Rheumatology"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1161\/CIRCULATIONAHA.121.054785","article-title":"Reduction in Kawasaki Disease After Nonpharmaceutical Interventions in the COVID\u201019 Era: A Nationwide Observational Study in Korea","volume":"143","author":"Kang J. M.","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1002\/art.42062","article-title":"American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS\u2010CoV\u20102 and Hyperinflammation in Pediatric COVID\u201019: Version 3","volume":"74","author":"Henderson L. A.","year":"2022","journal-title":"Arthritis and Rheumatology"},{"key":"e_1_2_11_26_1","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.cjca.2022.11.011","article-title":"Management of Multisystem Inflammatory Syndrome in Children: Decision\u2010Making Regarding a New Condition in the Absence of Clinical Trial Data","volume":"39","author":"Harahsheh A. S.","year":"2023","journal-title":"Canadian Journal of Cardiology"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24065711","article-title":"Immunology of Multisystem Inflammatory Syndrome After COVID\u201019 in Children: A Review of the Current Evidence","volume":"24","author":"Filippatos F.","year":"2023","journal-title":"International Journal of Molecular Sciences"}],"container-title":["Pediatrics International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70476","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ped.70476","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70476","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:51:53Z","timestamp":1783939913000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ped.70476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ped.70476"],"URL":"https:\/\/doi.org\/10.1111\/ped.70476","archive":["Portico"],"relation":{},"ISSN":["1328-8067","1442-200X"],"issn-type":[{"value":"1328-8067","type":"print"},{"value":"1442-200X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-03-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70476"}}