Limitation of Prediction on Intravenous Immunoglobulin Responsiveness in Kawasaki Disease.
- Author:
Seong Koo KIM
1
;
Ji Yoon HAN
;
Jung Woo RHIM
;
Jin Hee OH
;
Ji Whan HAN
;
Kyung Yil LEE
;
Jin Han KANG
;
Joon Sung LEE
Author Information
1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. jwrhim@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Kawasaki disease;
Mucocutaneous Lymph Node Syndrome;
Laboratory parameters;
Coronary artery lesion;
Intravenous Immunoglobulin;
Treatment response
- MeSH:
Cholesterol;
Coronary Vessels;
Fever;
Humans;
Immunoglobulins;
Immunoglobulins, Intravenous;
Inflammation;
Lymphocytes;
Mucocutaneous Lymph Node Syndrome;
Multivariate Analysis;
Neutrophils;
Platelet Count;
Sensitivity and Specificity;
Serum Albumin
- From:Korean Journal of Pediatric Infectious Diseases
2010;17(2):169-176
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We aimed to evaluate predictive parameters for non-response to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD) before IVIG use using two controls. METHODS: We evaluated 229 consecutive KD patients who were treated with 2 g/kg of IVIG at a single center. Those who had persistent fever >24 hours after IVIG infusion made up the 23 IVIG non-responders; the first control included a total 206 defervesced cases and the second control included 46 cases that were matched for age and pre-treatment fever duration to non-responders. RESULTS: Demographic and clinical characteristics were similar in IVIG non-responders and responders at presentation. As for laboratory findings, the neutrophil differential, CRP, AST, ALT, and LDH were higher, and lymphocyte differential, total protein, albumin, platelet count, and total cholesterol were significantly lower in IVIG non-responders compared to responders by univariate analysis in both study designs. However in multivariate analysis, non-responders showed a significantly higher neutrophil differential (cutoff value, >77%, sensitivity 68.4% and specificity 79.5%) and lower cholesterol (<124 mg/dL, sensitivity 79% and specificity 70.5%). Whereas plasma albumin (<3.6 g/dL, sensitivity 73.7% and specificity 60%) was the sole laboratory parameter of non-responders in the second study design. CONCLUSION: Severity of inflammation in KD was reflected by higher or lower laboratory values at presentation. Because the multivariate analysis for these indices may be influenced by some confounding factors, including the numbers of patients of different ages and fever duration, other assessment modalities are needed for KD patients with the greatest risk of coronary artery lesions.
