Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

  • Seo, Euri (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Jeong Jin (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jun, Hyun Ok (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Eun Jung (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Baek, Jae Suk (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hwue (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Jae-Kon (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2016.05.26
  • 심사 : 2016.08.29
  • 발행 : 2016.10.15
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초록

Purpose: This study investigated predictors of unresponsiveness to second-line intravenous immunoglobulin (IVIG) treatment for Kawasaki disease (KD). Methods: This was a single-center analysis of the medical records of 588 patients with KD who had been admitted to Asan Medical Center between 2006 and 2014. Related clinical and laboratory data were analyzed by univariate and multivariate logistic regression analyses. Results: Eighty (13.6%) of the 588 patients with KD were unresponsive to the initial IVIG treatment and received a second dose. For these 80 patients, univariate analysis of the laboratory results obtained before administering the second-line IVIG treatment showed that white blood cell count, neutrophil percent, hemoglobin level, platelet count, serum protein level, albumin level, potassium level, and C-reactive protein level were significant predictors. The addition of methyl prednisolone to the second-line regimen was not associated with treatment response (odds ratio [OR], 0.871; 95% confidence interval [CI], 0.216-3.512; P=0.846). Multivariate analysis revealed serum protein level to be the only predictor of unresponsiveness to the second-line treatment (OR, 0.160; 95% CI, 0.028-0.911; P=0.039). Receiver operating characteristic curve analysis to determine predictors of unresponsiveness to the second dose of IVIG showed a sensitivity of 100% and specificity of 72% at a serum protein cutoff level of <7.15 g/dL. Conclusion: The serum protein level of the patient prior to the second dose of IVIG is a significant predictor of unresponsiveness. The addition of methyl prednisolone to the second-line regimen produces no treatment benefit.

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참고문헌

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  1. Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment vol.61, pp.5, 2016, https://doi.org/10.3345/kjp.2018.61.5.160
  2. A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients vol.9, pp.None, 2016, https://doi.org/10.1038/s41598-019-39330-y
  3. A low-frequency IL4R locus variant in Japanese patients with intravenous immunoglobulin therapy-unresponsive Kawasaki disease vol.17, pp.1, 2019, https://doi.org/10.1186/s12969-019-0337-2
  4. Shock and unresponsiveness to repeated courses of intravenous immunoglobulin in Kawasaki disease: a nationwide database study vol.87, pp.5, 2020, https://doi.org/10.1038/s41390-019-0668-1
  5. A Retrospective Cohort Study of Intravenous Immunoglobulin Therapy in the Acute Phase of Kawasaki Disease: The Earlier, the Better? vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/6660407
  6. Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments vol.3, pp.10, 2021, https://doi.org/10.1002/acr2.11308
  7. Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease vol.21, pp.1, 2021, https://doi.org/10.1186/s12887-021-02876-w