Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease.
10.3349/ymj.2014.55.5.1260
- Author:
Yun Ju LIM
1
;
Jo Won JUNG
Author Information
1. Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
- Publication Type:Original Article
- Keywords:
Dexamethasone;
high-dose intravenous immunoglobulin;
combined therapy;
Kawasaki disease
- MeSH:
Child, Preschool;
Dexamethasone/administration & dosage/adverse effects/*therapeutic use;
Female;
Fever/drug therapy;
Glucocorticoids/administration & dosage/adverse effects/*therapeutic use;
Humans;
Immunoglobulins, Intravenous/administration & dosage/adverse effects/therapeutic use;
Immunologic Factors/administration & dosage/adverse effects/*therapeutic use;
Infant;
Length of Stay;
Male;
Mucocutaneous Lymph Node Syndrome/*drug therapy;
Treatment Outcome
- From:Yonsei Medical Journal
2014;55(5):1260-1266
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To investigate the clinical effects of a single high dose intravenous immunoglobulin (IVIG) combined with initial dexamethasone as a primary treatment on Kawasaki disease (KD). MATERIALS AND METHODS: Between January 2008 and December 2010, we reviewed the medical records of 216 patients with complete KD patients that were admitted to a single medical center. 106 patients were treated with a single high dose of IVIG (2 g/kg) alone and 110 patients received IVIG and dexamethasone (0.3 mg/kg per day for three days). RESULTS: The combined IVIG plus dexamethasone patient group had a significantly shorter febrile period and duration of hospital stay (1.4+/-0.7 days vs. 2.0+/-1.2 days, p<0.001; 5.8+/-1.7 days vs. 6.9+/-2.5 days, p<0.001, respectively) than the IVIG alone group. The combined IVIG plus dexamethasone group required IVIG retreatment significantly less than the IVIG only group (12.7% vs. 32%, p=0.003). After completion of the initial IVIG, C-reactive protein levels in the combined IVIG plus dexamethasone group were significantly lower than those in the IVIG only group (2.7+/-4.0 mg/dL vs. 4.6+/-8.7 mg/dL, p=0.03). In the combined IVIG plus dexamethasone group, the incidence of coronary artery lesions tended to be lower without worse outcomes at admission after initial infusion of IVIG and in follow-up at two months; however, the differences were not significant (8.2% vs. 11.3%, p=0.22; 0.9% vs. 2.8%, p=0.29). CONCLUSION: Initial combined therapy with dexamethasone and a single high-dose of IVIG resulted in an improved clinical course, in particular a shorter febrile period, less IVIG retreatment, and shorter hospital stay without worse coronary outcomes.
