Korean J Pediatr.  2016 Dec;59(12):477-482. 10.3345/kjp.2016.59.12.477.

Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease

• Lee HY
• Song MS

• KMID: 2367406
• DOI: http://doi.org/10.3345/kjp.2016.59.12.477

Abstract

PURPOSE
We conducted a study to determine which factors may be useful as predictive markers in identifying Kawasaki disease (KD) patients with a high risk of resistance to intravenous immunoglobulin (IVIG) and developing coronary artery lesions (CAL).
METHODS
We enrolled 287 patients in acute phase of KD at a single center. The demographic, clinical and laboratory data were collected retrospectively.
RESULTS
There were 34 patients in the IVIG resistant group. The IVIG resistant group had significantly higher serum N-terminal-pro-brain natriuretic protein (NT-proBNP) levels (P<0.01) and polymorphonuclear neutrophil (PMN) percentage (P<0.01) in comparison to the IVIG responders. The results yielded sensitivity (78.8%, 60.6%), specificity (58.2%, 90%) and cutoff value (628.6 pg/mL, 80.3%) of NT-proBNP and PMN respectively, in predicting IVIG resistance. Despite IVIG administration, 13 of the 287 patients developed CAL. The patients in the CAL group had higher NT-proBNP levels (P<0.01) and higher PMN percentage (P<0.01). In these patients, the results yielded sensitivity (73.3%, 56.7%), specificity (67.9%, 88.9%) and cutoff value (853.4 pg/mL, 80.3%) of NT-proBNP and PMN respectively, for predicting CAL. The area under the curve (AUC) for predicting resistance to IVIG was NT-proBNP 0.712, PMN 0.802. The AUC for predicting CAL was NT-proBNP 0.739, and PMN 0.773.
CONCLUSION
Serum NT-proBNP levels and PMN percentage were significantly elevated in patients with KD with IVIG resistance and CAL. Thus, they may be useful predicting markers for IVIG resistance and development of CAL in KD patients.

Keyword

Kawasaki disease; Immunoglobulin; Coronary artery; Pro-brain natriuretic protein; Neutrophils

MeSH Terms

Area Under Curve
Coronary Vessels*
Humans
Immunoglobulins*
Immunoglobulins, Intravenous
Mucocutaneous Lymph Node Syndrome*
Neutrophils
Retrospective Studies
Sensitivity and Specificity
Immunoglobulins
Immunoglobulins, Intravenous