Korean J Pediatr.  2013 Feb;56(2):75-79. 10.3345/kjp.2013.56.2.75.

Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease

• Park HM
• Lee DW
• Hyun MC
• Lee SB

• KMID: 2284822
• DOI: http://doi.org/10.3345/kjp.2013.56.2.75

Abstract

PURPOSE
It has been reported that 10% to 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment. In this study, we aimed to identify useful predictors of therapeutic failure in children with KD.
METHODS
We examined 309 children diagnosed with KD at the Kyungpook National University Hospital and the Inje University Busan Paik Hospital between January 2005 and June 2011. We retrospectively reviewed their medical records and analyzed multiple parameters in responders and nonresponders to IVIG.
RESULTS
Among the 309 children, 30 (9.7%) did not respond to IVIG. They had significantly higher proportion of neutrophils, and higher levels of aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, and N-terminal fragment of B-type natriuretic peptide than did responders. IVIG-nonresponders had a significantly longer duration of hospitalization, and more frequently experienced coronary artery lesion, and sterile pyuria. No differences in the duration of fever at initial treatment or, clinical features were noted.
CONCLUSION
Two independent predictors (ALT> or =84 IU/L, total bilirubin> or =0.9 mg/dL) for nonresponse were confirmed through multivariate logistic regression analysis. Thus elevated ALT and total bilirubin levels might be useful in predicting nonresponse to IVIG therapy in children with KD.

Keyword

Kawasaki disease; Intravenous immunoglobulin; Predictor; Alanine aminotransferase; Total bilirubin

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
Bilirubin
Child
Coronary Vessels
Fever
Hospitalization
Humans
Immunization, Passive
Immunoglobulins
Immunoglobulins, Intravenous
Logistic Models
Medical Records
Mucocutaneous Lymph Node Syndrome
Natriuretic Peptide, Brain
Neutrophils
Pyuria
Retrospective Studies
Alanine Transaminase
Aspartate Aminotransferases
Bilirubin
Immunoglobulins
Immunoglobulins, Intravenous
Natriuretic Peptide, Brain