Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a meta-analysis of 4442 cases

Abstract

The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ≤ 4.0 days after the onset of symptoms were more likely to be IVIG resistant.Conclusion: The initial administration of IVIG ≤ 4.0 days after the onset of symptoms increased ESR and decreased hemoglobin and platelet counts, oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, and polymorphous rash and are the risk factors for IVIG-resistant Kawasaki disease. What is Known: • Recent reports on this topic are about aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase, total bilirubin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), polymorphonuclear leukocytes (PMN), C-reactive protein (CRP), pro-brain natriuretic peptide (BNP), albumin, and sodium as the risk factors in the IVIG-resistant Kawasaki disease; however, no studies have been published on clinical features as predictors of IVIG resistance. What is New: • This meta-analysis identified the clinical features, the initial administration of IVIG ≤ 4.0 days after the onset of symptoms, and much more comprehensive laboratory indicators, such as hemoglobin, as predictors of IVIG-resistant Kawasaki disease. Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3182-2) contains supplementary material, which is available to authorized users.

Coronary Aneurysm and IVIG Resistance Prediction in Kawasaki Disease

“…[5,6] Based on a meta-analysis, when patients who were IVIG-resistant and -responsive were compared, the hemoglobin level, leukocyte and platelet counts, and ESR were statistically signi cant. [30] In our study the increased risk of IVIG resistance was shown to be statistically signi cant, especially in the group < 5 years of age. When the laboratory ndings of our IVIG-resistant patients were examined, a signi cant increase existed in the leukocyte count (marked neutrophil increase), platelet count, and CRP, ALT, troponin T and NT-proBNP levels, while the hematocrit and sodium levels were signi cantly decreased.…”

“…Indeed, there are several studies with similar results. [30][31][32][33] 33. Mann-Whitney U test was used for non-parametric testing c "Average" and "standard deviation" values in parentheses were speci ed for normally distributed data d "Median" and "lowest -highest values" in parentheses were speci ed for non-normally distributed data ALT: alanine transaminase; AST: aspartate aminotransferase; K: potassium; Na: sodium; NEU (%): neutrophil/leukocyte ratio; PLT: platelet count; NT-proBNP: N-terminal-pro-brain natriuretic peptide; WBC: White blood cell Mann-Whitney U test was used for non-parametric testing c "Average" and "standard deviation" values in parentheses were speci ed for normally distributed data d "Median" and "lowest -highest values" in parentheses were speci ed for non-normally distributed data ALT: alanine transaminase; AST: aspartate aminotransferase; K: potassium; Na: sodium; NEU (%): neutrophil/leukocyte ratio; PLT: platelet count; NT-proBNP: N-terminal-pro-brain natriuretic peptide; WBC: White blood cell…”

How useful are Kawasaki disease risk scoring systems to the Turkish population?

“…Between 10% and 20% of patients with KD have persistent or recurrent fever after primary therapy with IVIG plus ASA ( 2 , 22 , 23 ). Because the probability of coronary artery damage associated with IVIG-resistant KD is higher than IVIG-sensitive KD, the probability of damage to the coronary arteries would decrease, as well as the cost and hospitalization time, if patients with IVIG-resistant KD can be detected and appropriately treated before additional IVIG treatment ( 24 ).…”

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

“…Thus, the correlation between FC and IVIG unresponsiveness indicates that an elevation of FC levels in children with KD could be a re ection of pathogenesis that could lead to IVIG unresponsiveness. IVIG unresponsiveness in children with KD has been presumed to correlate with the severity of in ammation [23,24].…”