Risk Stratification in the Decision to Include Prednisolone With Intravenous Immunoglobulin in Primary Therapy of Kawasaki Disease

Kobayashi, Toshimitsu; Inoue, Yoshinari; Otani, Tetsuya; Morikawa, Akihiro; Kobayashi, T.; Takeuchi, Kazuo; Saji, Tsutomu; Sonobe, Tomoyoshi; Ogawa, Satoshi; Miura, Masaru; Arakawa, Hirokazu

doi:10.1097/inf.0b013e3181950b64

Cited by 66 publications

(47 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However the addition of corticosteroids to standard therapy did not decrease the incidence of coronary artery aneurysms or adverse events. Tohru et al [13] reported that prednisolone with IVIG treatment was associated with improvement in clinical and coronary outcomes for patients at high risk for being IVIG nonresponders. In other words, steroids with IVIG in the primary therapy for KD can relieve symptoms quickly and reduce the re-application of IVIG but not the probability of CAL occurrence.…”

Section: Discussionmentioning

confidence: 99%

Epidemiologic Survey of Kawasaki Disease in Jilin from 1999 Through 2008

Zhang

Liu

et al. 2011

Pediatr Cardiol

View full text Add to dashboard Cite

The epidemiologic pictures of Kawasaki disease (KD) in Jilin Province of China is still not clear. We sent a questionnaire form and diagnostic guidelines for KD to the province's 32 hospitals above the county and city level with pediatric in-patients. All patients with KD diagnosed during January 1999 through December 2008 were recruited in this survey. The incidence of KD was 1.39 to 11.07 (5.26 ± 3.97) per 100,000 children under the age of 5 years between 1999 and 2008. The ratio of male to female was 1.96 to 1. Ages at onset ranged from 58 days to 14 years. Patients under 5 years of age accounted of 88.73%. The disease occurred throughout the year, but it occurred more frequently in May to July and November. The most common cardiac abnormality was coronary artery dilatation (49.5%). Age at onset and hypoalbuminemia (<30 g/l) were selected for multivariate logistic regression equation. In conclusion, incidences of KD increased in Jilin Province. Age and gender distribution shared similarities with previous reports, and the seasonal distribution was different. Age and lower serum albumin were the most important risk factors of coronary arterial lesions (CAL) in KD. In addition, patients treated with steroids also had a possible heightened risk of contracting CAL.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiologic Survey of Kawasaki Disease in Jilin from 1999 Through 2008

Zhang

Liu

et al. 2011

Pediatr Cardiol

View full text Add to dashboard Cite

show abstract

“…Therefore, severe coronary complications might be avoided in high-risk patients by early initiation of intensive therapy. 11 It is also important to verify the efficacy of more intensive first-line therapies, including the additional therapies used to prevent CAA in patients at high risk for IVIG resistance. Among patients with high risk scores for failure of IVIG monotherapy, those treated with IVIG in combination with corticosteroids, highdose pulse methylprednisolone, cyclophosphamide, or infliximab were more likely to respond to therapy and avoid CAA.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Risk Score to Predict Intravenous Immunoglobulin Resistance in Patients With Kawasaki Disease

Seki¹,

Kobayashi²,

Kobayashi³

et al. 2011

Pediatric Infectious Disease Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…Sundel, et al9 suggested that the initial methylprednisolone therapy with IVIG as a primary therapy in KD led to faster resolution of fever, rapid improvement in inflammatory markers, and shorter length of hospitalization. Laboratory measurements, such as serum CRP, and clinical markers of the disease, such as a febrile duration, also improved more quickly in patients treated with IVIG and corticosteroids than those treated with IVIG alone 23,24. In a meta-analysis by Wooditch and Aronoff25 eight studies encompassing 862 children with KD in whom combined corticosteroid therapy with aspirin and IVIG were the initial treatment, were assessed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease

Lim

Jung

2014

Yonsei Med J

View full text Add to dashboard Cite

PurposeTo investigate the clinical effects of a single high dose intravenous immunoglobulin (IVIG) combined with initial dexamethasone as a primary treatment on Kawasaki disease (KD).Materials and MethodsBetween January 2008 and December 2010, we reviewed the medical records of 216 patients with complete KD patients that were admitted to a single medical center. 106 patients were treated with a single high dose of IVIG (2 g/kg) alone and 110 patients received IVIG and dexamethasone (0.3 mg/kg per day for three days).ResultsThe combined IVIG plus dexamethasone patient group had a significantly shorter febrile period and duration of hospital stay (1.4±0.7 days vs. 2.0±1.2 days, p<0.001; 5.8±1.7 days vs. 6.9±2.5 days, p<0.001, respectively) than the IVIG alone group. The combined IVIG plus dexamethasone group required IVIG retreatment significantly less than the IVIG only group (12.7% vs. 32%, p=0.003). After completion of the initial IVIG, C-reactive protein levels in the combined IVIG plus dexamethasone group were significantly lower than those in the IVIG only group (2.7±4.0 mg/dL vs. 4.6±8.7 mg/dL, p=0.03). In the combined IVIG plus dexamethasone group, the incidence of coronary artery lesions tended to be lower without worse outcomes at admission after initial infusion of IVIG and in follow-up at two months; however, the differences were not significant (8.2% vs. 11.3%, p=0.22; 0.9% vs. 2.8%, p=0.29).ConclusionInitial combined therapy with dexamethasone and a single high-dose of IVIG resulted in an improved clinical course, in particular a shorter febrile period, less IVIG retreatment, and shorter hospital stay without worse coronary outcomes.

show abstract

Risk Stratification in the Decision to Include Prednisolone With Intravenous Immunoglobulin in Primary Therapy of Kawasaki Disease

Abstract: IVIG + PSL treatment was associated with improving clinical and coronary outcomes in patients at high risk of being IVIG nonresponders.

Cited by 66 publications

References 34 publications

Epidemiologic Survey of Kawasaki Disease in Jilin from 1999 Through 2008

Epidemiologic Survey of Kawasaki Disease in Jilin from 1999 Through 2008

External Validation of a Risk Score to Predict Intravenous Immunoglobulin Resistance in Patients With Kawasaki Disease

Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease

Contact Info

Product

Resources

About