Browse > Article

Clinical characteristics and progress of Kawasaki disease patients who had early treatment with intravenous immune globulin  

Park, So-Yoon (Department of Pediatrics, College of Medicine, Yeungnam University)
Lee, Young Hwan (Department of Pediatrics, College of Medicine, Yeungnam University)
Publication Information
Clinical and Experimental Pediatrics / v.50, no.10, 2007 , pp. 1005-1010 More about this Journal
Abstract
Purpose : To determine the optimal time of high dose intravenous immune globulin (IVIG) treatment, we analysed the clinical characteristics and progress of a group of Kawasaki disease patients who had early treatment with IVIG. Method : A retrospective study was conducted of 188 patients with Kawasaki disease who were admitted to Yeungnam University Medical Center from January 2000 to December 2005. All patients were treated with a high dose IVIG and high dose aspirin for the initial acute phase treatment. The early treatment group consisted of 94 patients who received treatment before 5 days of fever, and the conventional group consisted of 94 patients who were treated on or after day 5. The patients' sex, age, laboratory findings, total duration of fever, duration of fever after initial IVIG, need for additional IVIG and coronary artery status were noted. Result : There were no significant differences between the two groups in sex ratio and age. No significant differences were noted in the level of WBC count, ESR, CRP, serum albumin, LDH, total duration of fever and coronary abnormality. But the value of ALT($151.8{\pm}17.3$ vs. $81.9{\pm}13.4$, P=0.002), duration of fever after initial IVIG ($3.8{\pm}0.5days$ vs. $2.1{\pm}0.2days$, P=0.003), and rate of additional IVIG (15.9% vs. 6.3%, P=0.037) were significantly higher in the early treatment group. There was no significant difference in initial dose of IVIG, but dosage of aspirin was lower in early treatment group (P=0.037). Conclusion : There is no evidence that early treatment of IVIG has greater efficacy in preventing cardiac sequelae than conventional treatment. In addition, early treatment is likely to result in a greater requirement for additional IVIG treatment.
Keywords
Kawasaki disease; Intravenous immune globulin; Treatment;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Muta H, Ishii M, Egami K, Furui J, Sugahara Y, Akagi T, et al. Early intravenous gamma-globulin treatment for Kawasaki disease the nationwide surveys in Japan. J Pediatr 2004;144:496-9   DOI   ScienceOn
2 Research Committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo, Japan: Ministry of Health and Welfare;1984
3 Sundel RP, Burns JC, Baker AS, Newburger JW, Gamma globulin retreatment in Kawasaki disease. J Pediatr 1993;123: 657-9   DOI   ScienceOn
4 Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-80   DOI   ScienceOn
5 Ayusawa M, Sonobe T, Demara S: Revision of diagnostic guidelines for Kawasaki diseaserthe 5th revised edition). Pediatr Int 2005:47:232-4   DOI   ScienceOn
6 Onouchi Z, Kawasaki T. Overview of pharmacological treatment of Kawasaki disease. Drugs 1990;58:813-22   DOI   ScienceOn
7 Nomura Y, Masuda K, Yoshinaga M, Sameshima K, Miyaga K. Patients diagnosed with Kawasaki disease before the fifth day of illness have a higher risk of coronary artery aneurysm. Pediatr Int 2002:44:353-7   DOI   ScienceOn
8 Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991;33:805-10   DOI
9 Han RK, Silverman ED, Newman A, McCrindle BW. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease. Arch Pediatr Adolesc Med 2000;154:694-9   DOI
10 Newburger JW, Fulton DR. Kawasaki disease. Curr Opin Pediatr 2004;16:508-14   DOI   ScienceOn
11 Shim SY, Heo MY, Kim HS, Sonh SJ. High-dose intravenous immune globulin retreatment in Kawasaki disease. J Korean Pediatr Soc 2002:45:1273-7
12 Tse SM, Silverman ED, McCrindle BW, Yeung RS. Early treatment with intravenous immunoglobulin in patients with Kawasaki disease. J Pediatr 2002;140:450-5   DOI   ScienceOn
13 Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et, al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004:46:33-8   DOI   ScienceOn
14 Wallace CA, French JW, Kahn SJ, Sherry DD. Initial intravenous gamma globulin treatment failure in Kawasaki disease. Pediatrics 2000;105:E78   DOI   ScienceOn
15 Yanagawa H, Nakamura Y, Sakata K, Yashiro M. Use of intravenousgarnrna-globulin for Kawasaki disease: effects on cardiac sequelae. Pediatr Cardiol 1997;18:19-23   DOI   ScienceOn
16 Kim EJ, Hong ME, Lee CW, Oh YG, Kim JD, Yoon HS. The clinical and laboratory features of Kawasaki disease with nonresponsibility to the acute antiinflammatory treatment. J Korean Pediatr Soc 2003:46:500-4
17 SugaharaY, Ishii M, Muta H, Furui J, Himeno W, Akagi T. The effectiveness and safety of early intravenous immune globulin treatment for Kawasaki disease. 7th International Kawasaki Disease Symposium; December 4-7,2001 Hakone, Japan; Japan Kawasaki Disease Research Center, 2001
18 Burns JC, Capparelli EV, Brown JA, Newburger JW, Glode MP. Intravenous gamma-globulin treatment and retreatrnent in Kawasaki disease. Pediatr Infect Dis J 1998;17:1144-8   DOI   ScienceOn
19 Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn J Allergy 1967;16:178-222
20 Yanagawa H, Nakimura Y, Yashiro M. The results of 16th nationwide survey of Kawasaki disease in Japan. J Pediatr Practice 2002;65:332-42
21 Mori M, Imagawa T, Yasui K, Kanaya A, Yokota S. Predictors of coronaryartery lesions after intravenous gammaglobulin treatment in Kawasaki disease. J Pediatr 2000;137: 177-80   DOI   ScienceOn
22 Freeman AF, Shulman ST. Kawasaki disease: summary of the American Heart Association guidelines. Am Fam Physician. 2006;74:1141-8
23 Newburger JW, Takahashi M, Bums JC, Beiser AS, Chung KJ, Duffy CE, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;315: 341-7   DOI   ScienceOn