Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prediction of nonresponsiveness to mediumdose intravenous immunoglobulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease

  • Moon, Kyung Pil (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Kim, Beom Joon (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Lee, Kyu Jin (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Oh, Jin Hee (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Han, Ji Whan (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Lee, Kyung Yil (Department of Pediatrics, The Catholic University of Korea College of Medicine) ;
  • Lee, Soon Ju (Department of Pediatrics, The Catholic University of Korea College of Medicine)
  • Received : 2015.09.15
  • Accepted : 2015.11.05
  • Published : 2016.04.15
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Abstract

Purpose: Medium-dose (1 g/kg) intravenous immunoglobulin (IVIG) is effective in the majority of patients with Kawasaki disease (KD) but some patients who do not respond to medium-dose IVIG are at high risk for the development of coronary artery lesions (CALs). The purpose of this study was to identify the clinical predictors associated with unresponsiveness to medium-dose IVIG and the development of CALs. Methods: A retrospective study was performed in 91 children with KD who were treated with mediumdose IVIG at our institution from January 2004 to December 2013. We classified the patients into responders (group 1; n=68) and nonresponders (group 2; n=23). We compared demographic, laboratory, and echocardiographic data between the 2 groups. Results: Multivariate logistic regression analysis identified 6 variables as predictors for resistance to medium-dose IVIG. We generated a predictive scoring system assigning 1 point each for percentage of neutrophils ${\geq}65%$, C-reactive protein ${\geq}100mg/L$, aspartate aminotransferase ${\geq}100IU/L$, and alanine aminotransferase ${\geq}100IU/L$, as well as 2 points for less than 5 days of illness, and serum sodium level ${\leq}136mmol/L$. Using a cutoff point of ${\geq}4$ with this scoring system, we could predict nonresponsiveness to medium-dose IVIG with 74% sensitivity and 71% specificity. Conclusion: If a patient has a low-risk score in this system, medium-dose IVIG can be recommended as the initial treatment. Through this process, we can minimize the adverse effects of high-dose IVIG and incidence of CALs.

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References

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