Impact factors for refractory KD and comparison of different treatment protocols

Abstract

Background Intravenous immunoglobulin (IVIG) has been widely accepted as a standard treatment against Kawasaki disease (KD). About 20% of patients are nonresponsive after the first IVIG treatment.This study was performed to reveal the responsiveness, mechanism of action, and incidence rate of coronary artery lesions in the long-term follow-up visit of action of IVIG combined with glucocorticoids in the treatment of refractory KD. Method: A total of 633 pediatric patients with KD (experimental group) and 200 pediatric patients with upper respiratory infection hospitalized during the same period (control group) were retrospective selected. KD was treated with IVIG combined with aspirin.IVIG-nonresponsive group was given the second treatment.Protocol 1 group was administered 1 g/kg IVIG; Protocol 2 group was administered 2 g/kg IVIG; and Protocol 3 group was administered 1 g/kg IVIG + glucocorticoid (GC). Following the second treatment, the responsive group (Group A) and nonresponsive group (Group B) were classified based on whether the temperature was reduced to normal. Results IVIG-nonresponsive group had more coronary artery lesions, longer time of first application of IVIG, and higher WBC count, ESR, CRP, and higher serum levels of Meprin A, IL-1β, IL-6, IL-17A, and IP-10. Protocol 3 group was found with faster abatement of fever, higher response rate, and fewer CALs. The serum levels of Meprin A, IL-1β, and IL-17A in Group B were higher, and the incidence rate of CAL after treatment was up to 78.9% . Conclusions The levels of Meprin A, IL-17A, and IL-1β may serve as potentially good indexes to predict refractory KD. IVIG combined with GC to treat refractory KD is more advantageous compared with IVIG alone.