Predictors of intravenous immunoglobulin resistance and coronary artery aneurysm in patients with Kawasaki disease

Chantasiriwan, Nattika; Silvilairat, Suchaya; Makonkawkeyoon, Krit; Pongprot, Yupada; Sittiwangkul, Rekwan

doi:10.1080/20469047.2018.1471381

Cited by 31 publications

(30 citation statements)

References 26 publications

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“…Previous frequently reported risk factors for CAL, such as a higher platelet level, 27 , 28 a lower albumin level, 28 , 29 male sex, 6 , 28 – 30 IVIG resistance 6 , 29 , 31 and receiving initial IVIG beyond 10 days, 6 , 27 , 28 , 32 were also demonstrated in our findings. As for incomplete KD, study results were contradictory even in multivariate analyses.…”

Section: Discussionsupporting

confidence: 84%

Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017

Xie

Yan

Huang

et al. 2020

Journal of Epidemiology

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Background We sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL). Methods As in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL. Results A total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL. Conclusions The incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.

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Section: Discussionsupporting

confidence: 84%

Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017

Xie

Yan

Huang

et al. 2020

Journal of Epidemiology

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“…The initial incidence of CALs judged by absolute diameter was 68% in IVIG-resistant group and 47% in IVIG-responsive group in this study. The initial CALs incidence in IVIG-resistant group was close to Han’s study 23 and was much higher than Chantasiriwan’s study 24 , but the incidences in IVIG-responsive groups were similar to theirs.…”

Section: Discussionsupporting

confidence: 65%

A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients

Tan

Zhang²,

Wang³

et al. 2019

Sci Rep

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Accurate evaluation of individual risk of intravenous immunoglobin (IVIG)-resistance is critical for adopting regimens for the first treatment and prevention of coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods: The KD patients hospitalized in Chongqing Children’s Hospital, in west China, from October 2007 to December 2017 were retrospectively reviewed. Data were collected and compared between IVIG-resistant group and IVIG-responsive group. The independent risk factors were determined using multivariate regression analysis. A new prediction model was built and compared with the previous models. Results: A total of 5277 subjects were studied and eight independent risk factors were identified including higher red blood cell distribution width (RDW), lower platelet count (PLT), lower percentage of lymphocyte (P-LYM), higher total bile acid (TBA), lower albumin, lower serum sodium level, higher degree of CALs (D-CALs) and younger age. The new predictive model showed an AUC of 0.74, sensitivity of 76% and specificity of 59%. For individual’s risk probability of IVIG-resistance, an equation was given. Conclusions: IVIG-resistance could be predicted by RDW, PLT, P-LYM, TBA, albumin, serum sodium level, D-CALs and age. The new model appeared to be superior to those previous models for KD population in Chongqing city.

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“…They speculated that, patients who were earlier diagnosed and treated were probably sicker and had greater inflammation. However, Chantashiriwan et al 24 reported duration of fever ≥ 8 days before IVIG as a predictor of coronary artery aneurism, similar with our results. Also, Gulhan et al 22 suggested administrating initial IVIG treatment within 7 days of illness to prevent cardiac complications.…”

Section: Discussionsupporting

confidence: 92%

Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease

Türkuçar¹,

Yıldız²,

Açarı³

et al. 2020

Turk J Pediatr

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Kawasaki disease (KD) is an acute, systemic, febrile vasculitis that occurs during infancy and is the most common cause of childhood coronary artery disease. 1 Although, its etiology has not been definitively determined, recent studies have focused on the increased inflammatory cytokines in KD pathology. 2-4 The clinical features include an existence of fever persisting more than five days with mucocutaneous and lymphatic manifestations that are commonly self-limiting. However, the most serious complication is the coronary artery involvement that can be mortal. With the routine use of intravenous immunoglobulin (IVIG) treatment, the incidence of coronary artery lesions (CALs) has declined from 23% to 8%. 5 On the other hand, some patients are at risk for resistance to IVIG treatment and development of CALs. 6 In Turkey, KD was reported as the second most common type of vasculitis in a nationwide study by Ozen et al. 7 , despite the real prevalence being unknown. Previous studies about KD from Turkey reported higher prevalence of coronary arterial involvement than Japanese children based studies. 8-12 Many studies have previously been conducted about the risk factors of KD, and patients with atypical age presentation, elevated acute phase reactants and liver function tests were reported as high risk. 10-12 The Japanese-based risk scoring systems such as that by Kobayashi, Egami, and Sano was reported as inadequate for fully determining the risks for IVIG resistance and CALs in Western populations living in North

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Predictors of intravenous immunoglobulin resistance and coronary artery aneurysm in patients with Kawasaki disease

Cited by 31 publications

References 26 publications

Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017

Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017

A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients

Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease

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