Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease

Abstract

:The objective of this study is the description of clinical outcomes regarding the absence of rescue therapy of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. I investigated the clinical outcomes of 33 IVIG-resistant patients who received the initial single IVIG therapy with the delayed use of antiinflammatory drugs (DUA). These patients were divided into two groups: 11 patients who received rescue therapies (rescue group) and 22 patients who did not receive rescue therapy (non-rescue group). One patient of rescue group developed coronary artery lesions (CAL). None of the patients of non-rescue group developed CAL. The prevalence of persistent fever between rescue and non-rescue groups at 3 days and 4 days after initial IVIG therapy was 100% vs. 77% ( P = 0.144 ) and 100% vs. 18% ( P < 0.001 ), respectively. The C-reactive protein value, neutrophil counts, serum albumin levels, and sodium levels were significantly different between two groups at median 3 days after initial IVIG therapy. Two-thirds of the IVIG-resistant patients diagnosed at 24 h after completion of the initial IVIG therapy with DUA did not develop CAL after 30 days of illness without rescue therapies. The rescue therapy at this time may lead to overtreatment.

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“…An initial single IVIG therapy with DUA is a challenging for preventing significant CAL caused by Kawasaki disease [3]. A recent study suggested that the decision to perform rescue therapy at 3 to 4 days after initial IVIG therapy with DUA was appropriate for preventing large CAL in initially IVIG-resistant patients [4]. However, the parameters to guide rescue therapies have not been established.…”

“…However, the parameters to guide rescue therapies have not been established. The c-reactive protein (CRP) ratio, defined as the ratio of CRP values after/before initial IVIG therapy, appeared to be useful for guiding rescue therapy [4]. However, this parameter could not identify high risk patients associated with CAL after 30 days of illness [4].…”