Comprehensive Assessment of the Risk of Developing Coronary Artery Aneurysm in Kawasaki Disease: A KawaCOR Score Study

Background: The early identification of high-risk patients is crucial in stratifying treatment algorithms for Kawasaki disease (KD). Our study aimed to develop a new scoring system to predict the risk of developing a coronary artery aneurysm (CAA) and the persistence of giant CAA during follow-up. Methods: A retrospective cohort study included 151 patients treated at our institute for KD between 2011 and 2025. Results: A total of 25 patients (16.5%) developed CAA, while, in the follow-up period, aneurysms were registered in nine patients. Based on the values obtained from the univariate analysis, a scoring system was developed. It included age 7 days, refractory KD, leucocytosis (>17 × 109), neutrophilia (>16 × 109), thrombocytosis (>400 × 109), anaemia (<103 g/L), hypoproteinaemia (<54 g/L), and hypoalbuminaemia (<32 g/L). Patients with a score ≥5 had an almost nine-fold higher risk of developing CAA (OR 8.7, 95% CI 3.4–22.6; p < 0.001), while, if the score was ≥8, the risk for a chronic giant aneurysm was 71 times higher (OR 71.5, 95%CI 8.5–597.7; p < 0.001). Based on the ROC curve, a score ≥5 has 99% sensitivity and 70% specificity for the development of CAA (AUC = 0.87). A score ≥7 has 100% sensitivity and 85% specificity for the development of giant aneurysms (AUC = 0.87). Conclusions: The KawaCOR score is the first scoring system in our region specifically designed to predict the development of CAA and acute and chronic giant CAA.