Guidelines for medical treatment of acute <scp>K</scp>awasaki disease: Report of the <scp>R</scp>esearch <scp>C</scp>ommittee of the <scp>J</scp>apanese <scp>S</scp>ociety of <scp>P</scp>ediatric <scp>C</scp>ardiology and <scp>C</scp>ardiac <scp>S</scp>urgery (2012 revised version)

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doi:10.1111/ped.12317

Cited by 143 publications

(75 citation statements)

References 111 publications

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“…The most effective second-line treatment in patients with KD that are refractory to initial treatment is still unclear23). Investigations regarding the efficacy of exclusive administration of corticosteroids as the second-line treatment have shown no superior protective effect for coronary artery lesions relative to additional IVIG administration15162425).…”

Section: Discussionmentioning

confidence: 99%

Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

Seo

Jun

et al. 2016

Korean J Pediatr

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PurposeThis study investigated predictors of unresponsiveness to second-line intravenous immunoglobulin (IVIG) treatment for Kawasaki disease (KD).MethodsThis was a single-center analysis of the medical records of 588 patients with KD who had been admitted to Asan Medical Center between 2006 and 2014. Related clinical and laboratory data were analyzed by univariate and multivariate logistic regression analyses.ResultsEighty (13.6%) of the 588 patients with KD were unresponsive to the initial IVIG treatment and received a second dose. For these 80 patients, univariate analysis of the laboratory results obtained before administering the second-line IVIG treatment showed that white blood cell count, neutrophil percent, hemoglobin level, platelet count, serum protein level, albumin level, potassium level, and C-reactive protein level were significant predictors. The addition of methyl prednisolone to the second-line regimen was not associated with treatment response (odds ratio [OR], 0.871; 95% confidence interval [CI], 0.216–3.512; P=0.846). Multivariate analysis revealed serum protein level to be the only predictor of unresponsiveness to the second-line treatment (OR, 0.160; 95% CI, 0.028–0.911; P=0.039). Receiver operating characteristic curve analysis to determine predictors of unresponsiveness to the second dose of IVIG showed a sensitivity of 100% and specificity of 72% at a serum protein cutoff level of <7.15 g/dL.ConclusionThe serum protein level of the patient prior to the second dose of IVIG is a significant predictor of unresponsiveness. The addition of methyl prednisolone to the second-line regimen produces no treatment benefit.

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Section: Discussionmentioning

confidence: 99%

Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

Seo

Jun

et al. 2016

Korean J Pediatr

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“…Persistent fever was used commonly as the definition, but the cut-off level of body temperature, the duration of observation for recrudescent fever, and whether or not the CRP level was used were different for each institute. The duration of observation for recrudescent fever is 36 h according to the definition of the AHA [13] , and 24 h was suggested in the recent Japanese guideline [39] . Intravenous methylprednisolone pulse therapy for 3 d was applied in all studies [22][23][24][25][26]40] .…”

Section: Unresponsive To Ivig Treatmentmentioning

confidence: 99%

Use of corticosteroids during acute phase of Kawasaki disease

Yu¹

2015

WJCP

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In spite of initial intravenous immunoglobulin (IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, have been considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids - the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.

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“…(GRADE A1) 247,250,251,252,253,254,255 R El uso de IgIV en asociación con ácido acetilsalicílico a dosis antiinflamatoria disminuye de forma significativa la frecuencia de aneurismas coronarios. La dosis recomendada es de 2 g/kg en una sola dosis.…”

Section: 251unclassified

“…(GRADE A1) 247,250,251,252,253,254,255 R Los pacientes que continúan con fiebre (EK resistente) después de la primera infusión están en mayor riesgo de aneurismas y deben recibir una segunda infusión con la misma dosis de 2 g/kg. (GRADE A1) 247,250,251,252,253,254,255 Síndrome de choque tóxico El síndrome de choque tóxico estreptocócico (TSS) es una infección invasiva, especialmente por Streptococcus pyogenes. Se asocia con elevada mortalidad, hasta de 70 %, por falla multiorgánica.…”

Section: 251unclassified

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

Olivares

Olmos²,

Álvarez

et al. 2017

RAM

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Immunoglobulins are heterodimeric proteins composed of 2 heavy chains and 2 light chains. Human immunoglobulin G (IgG) is a plasma derivative and contains more than 95% of IgG. The composition of IgG subclasses is similar to that of normal human plasma. Immunoglobulin therapy was first introduced more than 50 years ago, and its use has been described in numerous diseases. In Colombia, the importance of this immunomodulatory resource prompted the need for clinical practice guidelines to be available for its use. For this reason, a multidisciplinary group of experts was brought together and distributed in working groups, by specialties, in order to develop an initial manuscript. Systematic literature searches were undertaken; identified evidences were evaluated and classified to support a preliminary draft that was discussed, analyzed and amended. Recommendations were issued on the use of intravenous immunoglobulin in pathologies that include primary and secondary immunodeficiencies, autoimmune diseases, neurological disorders, infections, transplants and miscellaneous conditions; grades were assigned to each one of them according to the GRADE system. The final result translated into recommendations that are put forth with the purpose to inform, guide and support on optimal use of this immunomodulatory resource.

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Guidelines for medical treatment of acute Kawasaki disease: Report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version)

Cited by 143 publications

References 111 publications

Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

Use of corticosteroids during acute phase of Kawasaki disease

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

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