Predicting IVIG resistance in UK Kawasaki disease

Davies, Sarah L.; Sutton, Natalina; Blackstock, Sarah; Gormley, Stuart; Hoggart, Clive; Levin, Michael; Herberg, Jethro

doi:10.1136/archdischild-2014-307397

Cited by 123 publications

(98 citation statements)

References 5 publications

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“…As in the case of American and British authors, we verified the usefulness of KS (≥ 4 would be indicative of an increased risk of IVIG resistance) [11,12].…”

Section: Methodsmentioning

confidence: 60%

“…Additionally, we did not find a significant difference in relation to the response to IVIG therapy even when any other cut-off point in KS was considered. American and British researchers presented similar observations concerning the application of the scoring scale as a predictor of response to IVIG therapy [11,12]. Sleeper et al [11] in a prospective randomised study on a group of 99 patients with KD demonstrated high specificity (85-87%) but low sensitivity (33-42%) of Japanese scoring systems in the assessment of the risk of IVIG resistance in relation to the North American population (14% of subjects were of Asian origin) [11].…”

Section: Discussionmentioning

confidence: 74%

“…Data analysis of our patients in relation to the usefulness of KS to assess the risk of treatment resistance (scoring ≥ 4 as a factor of an increased risk of resistance) demonstrated that 21 (29%) of these patients fulfil the criteria for IVIG resistance [11,12]. In fact, only four of these patients did not respond to IVIG therapy, although none of the patients developed coronary artery abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…The Egami score was also of little usefulness in the prediction of the risk of resistance in relation to the San Diego population [17]. However, a retrospective assessment of KD patients hospitalised in the United Kingdom, which was based on KS, demonstrated both low sensitivity (58%) and specificity (33%) in predicting immunoglobulin resistance [12].…”

Section: Discussionmentioning

confidence: 99%

“…These authors reported that the addition of corticosteroids statistically significantly decreased the risk of aneurysms (3% vs. 23%, p < 0.0001). However, in single studies related to populations other than Japanese, the authors did not demonstrate high usefulness of KS to assess the risk of resistance to KD treatment [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Berdej-Szczot¹,

Małecka-Tendera

Gawlik

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: The risk of immunoglobulin resistance is still likely to occur in Kawasaki disease (KD) despite adequate treatment. The Kobayashi score (KS) is used to predict unresponsiveness to treatment although the usefulness of the score in populations other than Asian seems to be debatable. Aim:The analysis of clinical and laboratory parameters predisposing to immunoglobulin resistance and coronary complications in children hospitalised due to KD. Methods:The data of children hospitalised due to KD between 2003 and 2016 underwent analysis. Clinical and laboratory parameters were analysed, including all parameters present in KS in relation to the risk of intravenous immunoglobulin (IVIG) resistance and the occurrence of coronary complications in the form of aneurysms and dilatations.Results: Seventy-three children (51 boys; aged 1.5-135 months) with KD were hospitalised. In eight (11%) patients IVIG resistance was observed. We reported aneurysms or coronary dilatations in 13 (17.8%) children. The criterion for increased risk of IVIG resistance based on KS (≥ 4 points) was fulfilled by 21 (29%) children. Resistance to IVIG and coronary complications were observed in four (19.1%) and two (9.5%) children with the score ≥ 4 points, respectively, and four (7.7%) and 11 (21.6%) from the group < 4 points in KS, respectively. The prevalence of IVIG resistance and coronary artery complications was not different between the group with ≥ 4 and the group with < 4 points (p = 0.22, p = 0.32, respectively). A higher risk of IVIG resistance was confirmed in children with a longer duration of fever (13.0 days with IVIG resistance vs. 9.2 days with a good response to IVIG, p = 0.04). For the prediction of the occurrence of coronary artery aneurysms the following were of great importance: the day of diagnosis (which was usually the day of the beginning of treatment), the number of symptoms, and the maximal platelet count (p = 0.001; p = 0.019 and p = 0.026, respectively). Conclusions:In our study population we did not demonstrate the usefulness of KS to predict IVIG resistance or the risk of the occurrence of coronary artery aneurysms. However, prolonged fever, late diagnosis, poorly symptomatic course of the disease, and a high platelet count at the time of the follow-up remain independent risk factors.

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“…As in the case of American and British authors, we verified the usefulness of KS (≥ 4 would be indicative of an increased risk of IVIG resistance) [11,12].…”

Section: Methodsmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Berdej-Szczot¹,

Małecka-Tendera

Gawlik

et al. 2017

Kardiol Pol

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Caution in Generalizing the Use of Adjunctive Primary Corticosteroids in Kawasaki Disease to Unselected Non-Japanese Populations

2017

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than the value of a single number and whether that number exceeds an arbitrary threshold. The ASA [American Statistical Association] statement is intended to steer research into a 'post P <.05 era.'" 1 Much of the criticism for our study involved sensitivity analysis in the Supplement. However, the focus of this study was to use a method that uncovers the effects of familial-level confounding by virtue of design and does not require the inclusion of a large number of confounders. This approach is in addition to observational designs that statistically adjust for measured confounders because it demonstrates the existence of residual confounding that can remain a problem no matter how many measured confounders are included. Given this design, including covariates as well as adjusting for postnatal or partner's acetaminophen use can result in an overadjusted model.

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Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments

James

Kalot

Husainat

et al. 2021

ACR Open Rheumatology

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Objective Kawasaki disease (KD) is a self‐limited vasculitis affecting medium‐sized vessels with a predilection for the coronary arteries. Although treatment reduces the likelihood of developing of coronary artery aneurysms, 5% of patients still develop aneurysms despite treatment, making KD the leading cause of acquired heart disease in children in the United States. Consequently, there is a great deal of interest in optimizing treatment regimens, particularly for higher‐risk patients, to decrease morbidity. The aim of this systematic review is to support the development of the American College of Rheumatology/Vasculitis Foundation for the diagnosis and management of KD, focusing on the more complex scenarios in which rheumatologists may become involved, such as high‐risk and refractory disease. Methods Eighty‐nine articles were considered for full review in this systematic literature review to address 16 Population, Intervention, Comparison, and Outcome questions related to KD. Data were abstracted in hierarchical fashion. Randomized control trials (RCTs) were considered first; if none were identified or if they contained insufficient information, comparative observational studies were then viewed, followed by single‐arm observational studies/single arms from comparative studies. Only observational studies with more than 10 subjects with vasculitis were included. Results Eight RCTs and 28 observational studies that addressed the questions were identified. Two questions were addressed by RCTs, seven questions had at least some comparative observational studies, three questions were only addressed by single‐arm data, and four questions had no relevant studies. Conclusion This systematic review evaluates the benefits and harms of treatments for KD beyond first‐line therapy.

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Predicting IVIG resistance in UK Kawasaki disease

Cited by 123 publications

References 5 publications

Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Caution in Generalizing the Use of Adjunctive Primary Corticosteroids in Kawasaki Disease to Unselected Non-Japanese Populations

Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments

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