Korean Circ J.  2018 Jan;48(1):71-79. 10.4070/kcj.2017.0136.

Factors Predicting Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Lesion in Patients with Kawasaki Disease: Analysis of the Korean Nationwide Multicenter Survey from 2012 to 2014

• Kim MK
• Song MS
• Kim GB

• KMID: 2405047
• DOI: http://doi.org/10.4070/kcj.2017.0136

Abstract

BACKGROUND AND OBJECTIVES
Approximately 10-15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD.
METHODS
We retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals.
RESULTS
Among 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p < 0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p < 0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p < 0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p < 0.01), while PMN, NT-proBNP, AST, and ALT were not.
CONCLUSIONS
Elevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.

Keyword

Mucocutaneous lymph node syndrome; Intravenous immunoglobulins; Coronary artery disease; Natriuretic peptide, Brain; Neutrophils

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
C-Reactive Protein
Child
Coronary Artery Disease
Coronary Vessels*
Humans
Immunoglobulins*
Immunoglobulins, Intravenous
Logistic Models
Mucocutaneous Lymph Node Syndrome*
Natriuretic Peptide, Brain
Neutrophils
Retrospective Studies
Alanine Transaminase
Aspartate Aminotransferases
C-Reactive Protein
Immunoglobulins
Immunoglobulins, Intravenous
Natriuretic Peptide, Brain

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