Browse > Article

Limitation of Prediction on Intravenous Immunoglobulin Responsiveness in Kawasaki Disease  

Kim, Seong-Koo (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Han, Ji-Yoon (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Rhim, Jung Woo (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Oh, Jin Hee (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Han, Ji-Whan (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Lee, Kyung Yil (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Kang, Jin-Han (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Lee, Joon-Sung (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Publication Information
Pediatric Infection and Vaccine / v.17, no.2, 2010 , pp. 169-176 More about this Journal
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.
Keywords
Kawasaki disease; Mucocutaneous Lymph Node Syndrome; Laboratory parameters; Coronary artery lesion; Intravenous Immunoglobulin; Treatment response;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Kawasaki T. Kawasaki disease. Historical background and current issues. Prog Clin Biol Res 1987;250:1-4.
2 Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and longterm management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33.   DOI   ScienceOn
3 Burgner D, Harnden A. Kawasaki disease: what is the epidemiology telling us about the aetiology? Int J Infec Dis 2005;9:185-94.   DOI   ScienceOn
4 Lee KY, Han JW, Lee JS. Kawasaki disease may be a hyperimmune reaction of genetically-susceptible children to variants of normal environmental flora. Med Hypotheses 2007;69:642-51.   DOI   ScienceOn
5 Furusho K, Kamiya T, Nakano H, Kiyosawa N, Shinomiya K, Hayashidera T, et al. High dose intravenous gamma globulin therapy for Kawasaki syndrome. Lancet 1984;2:1055-8.
6 Newberger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of Kawasaki syndrome. N Engl J Med 1991; 324:1633-9.   DOI   ScienceOn
7 Wright DA, Newburger JW, Baker A, Sundel RP. Treatment of immunoglobulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 1996;128:146-9.   DOI   ScienceOn
8 Burns JC, Capparelli EV, Brown JA, Newburger JW, Glode MP. Intravenous gamma-globulin treatment and retreatment in Kawasaki disease: US/Canadian Kawasaki Syndrome Study Group. Pediatr Infect Dis J 1998;17: 1144-8.   DOI   ScienceOn
9 Burns JC, Mason WH, Hauger SB, Janai H, Bastian JF, Wohrley JD, et al. Infliximab treatment for refractory Kawasaki syndrome. J Pediatr 2005;146:662-7.   DOI   ScienceOn
10 Nakano H, Ueda K, Saito A, Tsuchitani Y, Kawamori J, Miyake T, et al. Scoring method for identifying patients with Kawasaki disease at high risk coronary artery aneurysms. Am J Cardiol 1986;58:739-42.   DOI   ScienceOn
11 Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986;108:388-92.   DOI
12 Mori M, Imagawa T, Yasui K, Kanaya A, Yokota S. Predictors of coronary artery lesions after intravenous $\gamma$-globulin treatment in Kawasaki disease. J Pediatr 2000;137:177-80.   DOI   ScienceOn
13 Beiser AS, Takahashi M, Baker AL, Sundel RP, Newburger JW. A predictive instrument for coronary artery aneuryms in Kawasaki disease. Am J Cardiol 1998;81: 1116-20.   DOI   ScienceOn
14 Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Pediatr Jpn 1991;33:805-10.   DOI
15 McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, et al. Coronary artery involvement in children with Kawasaki disease; risk factors from analysis of serial normalized measurements. Circulation 2007;116:174-9.   DOI   ScienceOn
16 Fukunishi M, Kikkawa M, Hamana K, Onodera T, Matsuzaki K, Matsumoto Y, et al. Prediction of nonresponsiveness to intravenous high-dose $\gamma$-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 2000;137:172-6.   DOI   ScienceOn
17 Durongpisitkul K, Soongswang J, Laohaprasitiporn D, Nana A, Prachuabmoh C, Kangkagate C. Immunoglobulin failure and retreatment in Kawasaki diseasae. Pediatr Cardiol 2003;24:145-8.   DOI   ScienceOn
18 Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006;149:237-40.   DOI   ScienceOn
19 Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12.   DOI   ScienceOn
20 20) Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007;166:131-7.
21 Uehara R, Belay ED, Maddox RA, Holman RC, Nakamura Y, Yashiro M, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 2008;27:155-60.
22 Tremoulet AH, Best BM, Song S, Wang S, Corinaldesi E, Eichenfield JR, et al. Resistance to intravenous immunoglobulin in children with Kawasaki disease. J Pediatr 2008;153:117-21.   DOI   ScienceOn
23 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
24 Lee KY, Hong JH, Han JW, Lee JS, Lee BC, Burgner D. Features of Kawasaki disease at the extreams of age. J Paediatr Child Health 2006;42:423-7.   DOI   ScienceOn
25 Lee KY, Han JW, Hong JH, Lee HS, Lee JS, Whang KT. Inflammatory processes in Kawasaki disease reach their peak at the sixth day of fever onset: laboratory profiles according to duration of fever. J Korean Med Sci 2004;19:765-71.
26 Checchia PA, Borensztajn J, Schulman ST. Circulating cardiac troponin I levels in Kawasaki disease. Pediatr Cardiol 2001;22:102-6.   DOI   ScienceOn
27 Kelley-Hedgepeth A, Lloyd-Jones DM, Colvin A, Matthews KA, Johnston J, Sowers MR, et al. Ethnic differences in C-reactive protein concentration. Clin Chem 2008;54:1027-37.   DOI   ScienceOn
28 Sakata K, Hamaoka K, Ozawa S, Niboshi A, Yoshihara T, Nishiki T, et al. A randomized prospective study on the use of 2 g-IVIG or 1 g-IVIG as therapy for Kawasaki disease. Eur J Pediatr 2007;16:565-71.
29 Hwang JY, Lee KY, Rhim JW, Youn YS, Oh JH, Han JW, et al. Assessment of intravenous immunoglobulin non-responders in Kawasaki disease. Arch Dis Child 2010 Jun 15. [Epub ahead of print]
30 Lee KY, Lee HS, Hong JH, Han JW, Lee JS, Whang KT. High-dose intravenous immunoglobulin downregulates the activated levels of inflammatory indices except erythrocyte sedimentation rate in acute stage of Kawasaki disease. J Trop Pediatr 2005;51:98-101.   DOI   ScienceOn
31 Kushner HI, Macnee RP, Burns JC. Kawasaki disease in India: increasing awareness or increased incidence? Perspect Biol Med 2009;52:17-29.
32 Du ZD, Zhao D, Du J, Zhang YL, Lin Y, Liu C, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004. Pediatr Infect Dis J 2007;26: 449-51.   DOI   ScienceOn