Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

Abstract

Background and ObjectivesThe prevalence of incomplete Kawasaki disease (iKD) is progressively increasing. We aimed to retrospectively investigate the predictors of intravenous immunoglobulin (IVIG) resistance in iKD patients and compare them with those of IVIG resistance in complete Kawasaki disease (cKD) patients. We also compared the prognosis of coronary artery lesions (CALs) between the IVIG non-responders and responders in both iKD and cKD groups.Subjects and MethodsA total of 234 cKD and 77 iKD patients were treated with IVIG between February 2009 and April 2012. Among these 311 patients, we reviewed the data of 77 iKD patients and 75 age-matched cKD patients.ResultsPatients with iKD having an elevated neutrophil count {percentage of segmented neutrophils (SEG%) ≥79.0} were at risk of IVIG resistance, while patients with cKD having SEG% ≥79.25 and serum total bilirubin (TB) ≥0.56 mg/dL were at risk of IVIG resistance as shown by multivariable logistic regression analysis. Fractional changes of laboratory data before and after IVIG treatment showed that Creactive protein (CRP) and N-terminal B type natriuretic peptide (NT-proBNP) levels were significantly elevated in IVIG non-responders of the iKD group, whereas erythrocyte sedimentation rate was significantly elevated in IVIG non-responders of the cKD group. Among the patients who had CALs at 10 months after the start of illness, the z scores of coronary arteries were higher in IVIG non-responders of the iKD group, when compared with IVIG non-responders of the cKD group.ConclusionElevated SEG%, changes in CRP and NT-proBNP levels may help in early detection of IVIG resistance in patients of the iKD group, which may aid in predicting the prognosis of CALs in these patients. Further studies with a larger number of patients are warranted.

Septik Şok Gelişen Atipik Kawasaki Olgusu

“…Hastalarda en sık görülen bulgu uzun süre devam eden ateştir. Diğer bulgular da saptandığı zaman tanı kolaylıkla düşünülebilir ancak tanı koymanın zor olduğu inkomplet ve atipik KH olguları da vardır (6)(7)(8). Ateş kriterini ve diğer beş kriterden en az ikisini (dörtten azını) karşılayan ve EKO incelemesinde koroner arter anevrizması görülen olgular inkomplet olgulardır.…”

“…arter değişiklikleri; belirti vermeyen koroner arter genişlemesinden, tromboze dev koroner arter anevrizması, miyokard infarktüsü ve ani ölümlere neden olacak kadar geniş bir klinik bulgu verebilmektedir (2, 6,7). Bu komplikasyonların önlenebilmesi için erken tanı konulması, intravenöz immünglobulin (IVIG) ve yüksek doz asetilsalisilik asit (ASA) tedavisinin erken dönemde başlanması önemlidir (6).…”

Risk of coronary artery involvement in Kawasaki disease

“…In our study, in the complete form of KD, gastrointestinal symptoms and higher bilirubin levels were also significantly related to CAD. Similarly, K. H. Cho et al, 15 retrospectively analyzed predictive factors of resistance to immunoglobulin therapy in 311 patients with complete and incomplete KD and found that, in patients with complete KD, total bilirubin levels >0.56 mg/dL were significant predictors of resistance.…”

The Efficacy and Safety of High-Dose Intravenous Immunoglobulin in the Treatment of Kawasaki Disease: How Can We Predict Resistance to Intravenous Immunoglobulin Treatment of Kawasaki Disease?

“…Other studies of the predictors of IVIG resistance have focused only on patients with cKD11)31) or iKD,32) respectively. Those studies also found that an elevated percentage of segmented neutrophils was of value for predicting IVIG resistance in patients with iKD, supporting leukocytosis as a characteristic finding during the acute phase of KD, especially the dominance of polymorphonuclear leukocytes 33)…”