Impact of Early Treatment with High-Dose Intravenous Immunoglobulin on Incidence of Kawasaki Disease Complications in Iranian Children

Abstract

Objective: Kawasaki disease (KD) occurs in five-year-old or younger children. This study aimed to evaluate the impact of high-dose intravenous immunoglobulin plus acetylsalicylic acid therapy on the prevention and treatment of coronary artery lesions and to evaluate the impact of high-dose acetylsalicylic acid (ASA) on the hearing of the patients.
 Materials and methods: In this retrospective cohort study, 31 patients with KD were followed from January 2012 to December 2015. The clinical, para-clinical, color Doppler echocardiogram and audiometry results were evaluated.
 Results: Overall, seven cases (22.6%) developed coronary artery aneurysm (CAA) in the acute phase of the disease, of whom only two still had CAA at the end of the treatment (6%). One of the five children with CAA recovery had a delay in the onset of treatment and one of two patients with persistent CAA at the end of treatment was admitted within the first 10 days. There was no evidence-based abnormal liver biochemical test. None of the patients developed sensorineural hearing loss (SNHL) on audiometry tests conducted before and after treatment.
 Conclusion: Recovery of coronary artery lesions was 71.43% after 28 days of the onset of treatment. The distribution of coronary artery aneurysm was not different in terms of the time of the treatment initiation (P-Value = 0.371). None of the children had a sensorineural hearing loss (SNHL) 48 hours and 4 weeks after treatment.

The therapeutic window of intravenous immunoglobulin (IVIG) and its correlation with clinical outcomes in Kawasaki disease: a systematic review and meta-analysis

“…After screening of full texts, 18 articles that did not meet the inclusion criteria were excluded (reasons for exclusion are summarized in Supplementary Material, Appendix S2 ). A total of 27 studies [ 9 – 13 , 19 – 40 ] met the inclusion criteria and were analyzed for the systemic review and meta-analysis (Fig. 1 ).…”

“…Most of the studies were observational. Eighteen (66.7%) were cohort studies [ 9 , 10 , 12 , 13 , 19 – 32 ], three (11.1%) were case-control studies [ 11 , 33 , 34 ], and six (22.2%) were RCTs [ 35 – 40 ]. The included articles showed that the clinical outcomes differed among four categories (start of IVIG therapy up to 4 days, 5 to 7 days, 8 to 10 days, and more than 10 days).…”

“…Due to a lack of data, we did not include repeated IVIG resistance in our analysis. Of the 27 studies, 21 studies [ 9 – 13 , 19 , 21 , 23 – 25 , 28 , 29 , 31 – 33 , 35 – 40 ] including 36,499 participants reported initial IVIG resistance, and 5764 had IVIG resistance (15.8%). Very low-quality evidence showed that, using day 4 of fever as the cut-off point, the early group ( ≦ 4 days) had a higher initial IVIG-resistance (RR, 1.80; 95% CI, 1.50–2.15; P < .00001; I 2 = 75%) than the late group (>4 days), with 21.6% (2699 of 12,481) in the early group VS 12.2% (2720 of 22,277) in the late group (Fig.…”

“…21 studies [ 9 – 13 , 19 , 21 , 23 – 25 , 28 , 29 , 31 – 33 , 35 – 40 ] including 38,587 participants investigated the occurrence of CALs in the acute phase, and 4172 had CALs (10.8%). Very low-quality evidence showed that using day 4 of fever as the cut-off point, the two groups of KD patients had a similar likelihood of CALs in the acute phase (RR, 0.92; 95% CI, 0.77–1.10; P = .37; I 2 = 70%) (Fig.…”

“…13 studies [ 9 , 11 , 12 , 19 – 23 , 25 , 29 , 31 , 33 , 39 ] reported CALs during 1–2 months follow-up (654 of 6652 [9.8%] vs. 696 of 6995 [9.9%]). The pooled analysis showed that delaying IVIG treatment for more than 10 days was associated with a higher risk of CALs during 1–2 months follow-up than the earlier treatment (OR, 0.49; 95% CI, 0.32–0.76; P = .002; I 2 = 75%).…”