Korean Circ J.  2014 Nov;44(6):415-422. 10.4070/kcj.2014.44.6.415.

Prediction of Resistance to Standard Intravenous Immunoglobulin Therapy in Kawasaki Disease

• Lee SM
• Lee JB
• Go YB
• Song HY
• Lee BJ
• Kwak JH

• KMID: 2223858
• DOI: http://doi.org/10.4070/kcj.2014.44.6.415

Abstract

BACKGROUND AND OBJECTIVES
Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD.
SUBJECTS AND METHODS
We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant.
RESULTS
Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance.
CONCLUSION
Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients.

Keyword

Kawasaki disease; Immunoglobulins, intravenous; Risk factors

MeSH Terms

Blood Sedimentation
C-Reactive Protein
Child
Creatine Kinase
Eosinophils
Humans
Immunization, Passive*
Immunoglobulins
Immunoglobulins, Intravenous
Leukocyte Count
Lymphocytes
Medical Records
Mucocutaneous Lymph Node Syndrome*
Multivariate Analysis
Neutrophils
Platelet Count
Retreatment
Retrospective Studies
Risk Factors
Sodium
C-Reactive Protein
Creatine Kinase
Immunoglobulins
Immunoglobulins, Intravenous
Sodium

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