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

Li, Zheng; Cai, Jingye; Lü, Jing; Wang, Mingju; Yang, Chenmei; Zhang, Zheng; Tang, Qian; Li, Jianhong; Tang, Wenqi; Luo, Hui; Pan, Gaofeng; Zeng, Xingmao

doi:10.1186/s13052-023-01451-6

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…The current KD and MIS treatments are high-dose aspirin, IVIG, and, sometimes, a corticosteroid. IVIG treatment within 7 days of illness onset lowers the risk of the patient developing coronary artery lesions and cardiac sequelae [ 113 ]. Treatment with aspirin also lowers the risk of developing coronary artery lesions [ 114 ].…”

Section: Discussionmentioning

confidence: 99%

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

Ricke,

Smith

2024

Life

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Background: Vasculitis diseases include Kawasaki disease (KD), Kawasaki disease shock syndrome (KDSS), Multisystem Inflammatory Syndrome (MIS), Henoch–Schönlein purpura (HS), or IgA vasculitis, and additional vasculitis diseases. These diseases are often preceded by infections or immunizations. Disease incidence rates are higher in children than in adults. These diseases have been extensively studied, but understanding of the disease etiology remains to be established. Objective: Many studies have failed to demonstrate an association between vasculitis diseases and vaccination; this study examines possible associations. Methods: Herein, the Vaccine Adverse Event Reporting System (VAERS) database is retrospectively examined for associations between vasculitis diseases and immunizations. Results: For some vaccines, the number of rare cases of KD, MIS, and HS are higher than the background rates. These rare cases are predicted to occur in individuals with (1) genetic risk factors with (2) antibody titer levels above the primary immune response level. Herein, the model of humoral immune response antibodies bound to antigens (pathogen or vaccine) creating immune complexes is proposed. These immune complexes are proposed to bind Fc receptors on immune cells and platelets, resulting in cell activation and the release of inflammatory molecules including histamine and serotonin. Immune complexes and inflammatory molecules including serotonin and histamine likely trigger vasculitis. Elevated serotonin and possibly histamine drive initial vasoconstrictions, disrupting blood flow. Increased blood flow pressure from cardiac capillary vasoconstrictions is predicted to trigger coronary artery aneurysms (CAA) or lesions (CAL) in some patients. For KDSS and MIS patients, these cardiac capillary vasoconstrictions are predicted to result in ischemia followed by ventricular dysfunction. Ongoing ischemia can result in long-term cardiac damage. Cases associated with pathogens are likely to have persistent infections triggering disease onset. Conclusion: The proposed model of immune complexes driving disease initial disease etiology by Fc receptor activation of immune cells and platelets, resulting in elevated histamine and serotonin levels, is testable and is consistent with disease symptoms and current treatments.

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Section: Discussionmentioning

confidence: 99%

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

Ricke,

Smith

2024

Life

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“…Different clinical guidelines recommend IVIG as the first-line therapy to treat KD [ 1 , 9 ]. Standard treatment with IVIG and aspirin significantly reduces the prevalence of CALs [ 10 ]. Nevertheless, about 10–20% of KD patients were IVIG-resistant and at a higher risk of developing cardiac complications [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of albumin for intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients

et al. 2023

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Background Intravenous immunoglobulin (IVIG) has been the mainstay of treatment for Kawasaki disease (KD) over the past decades. However, 10–20% of KD patients are resistant to IVIG treatment which puts those patients at high risk of coronary artery lesions (CALs). Therefore, it is important to predict whether patients will be resistant to IVIG before the treatment. This study aimed to investigate the risk factors for IVIG non-responsive patients with KD. Methods This study enrolled patients diagnosed with KD and divided them into two groups, IVIG responders and IVIG non-responders. We compared the differences in demographics and clinical data between the two groups. Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results In total, 907 KD patients were reviewed, with 841 IVIG responders and 66 IVIG non-responders. Patients in IVIG responders were younger than IVIG non-responders. The length of hospitalization of the IVIG non-responders was significantly longer than IVIG responders. The neutrophils%, C-reaction protein (CRP), and CRP/albumin ratio in IVIG responders were significantly lower than in IVIG non-responders (P < 0.05). The lymphocyte% and Albumin in IVIG responders were significantly higher than in IVIG non-responders. Multivariable logistic regression analysis demonstrated that albumin (OR = 0.881, 95% CI, 0.781 to 0.994, p-value = 0.039) was an independent risk factor for predicting IVIG resistance. The area under the ROC curve was 0.644, with a cut-off of ≤ 33.4 g/L determined by Youden’s index. The sensitivity and specificity in predicting IVIG resistance were 40.91% and 83.47%, respectively. Conclusion Albumin can serve as a potential predicting marker for IVIG resistance in KD. A lower albumin level may be useful for identifying KD patients with a high risk of IVIG resistance to guide further therapy strategies.

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“…The standard of care for acute KD is intravenous immune globulin (IVIG), which declines the proportion from 25% to 5%. 4 , 5 In addition, the lack of a diagnostic assay for KD poses challenges in identifying the condition and initiating IVIG treatment promptly, leading to increased morbidity and mortality associated with KD.…”

Section: Introductionmentioning

confidence: 99%

Expression of oxidative stress and inflammatory indicators for coronary artery disease in Kawasaki disease

Zhang

2024

Mediterr J Hematol Infect Dis

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Background: The paper was to investigate the clinical relevance of oxidative stress (OS) and inflammation-associated target in coronary artery lesions (CALs) associated with Kawasaki disease (KD). Methods: The data of clinical from 455 sufferers diagnosed with KD between February 2021 and June 2023 were gathered and fell into two groups: CAL and NCAL. The regression analysis was conducted to search independent covariates for CALs related to OS and inflammation. The predictive nomogram was structured according to these risk factors. The properties of the model were estimated using calibration and receiver operating characteristic curves. Results: The levels of CRP, IL-6, PLT count, ESR, ox-HDL, MDA, and PLR were dramatically more elevate, interestingly, HDL and SOD were low in the CAL group. Ascension of CRP, IL-6, ESR, ox-HDL, MDA, and PLR, and diminution of HDL and SOD were considered as independent risk factors. The nomogram constructed using these factors demonstrated a satisfactory calibration degree and discriminatory power, with an area under the curve of 0.812. In the verification set, the area under the curve was found to be 0.799. Conclusion: The model was established according to 8 OS and inflammation- associated risk factors bound up with CALs in sufferers with KD, and maybe a usable approach for early diagnosis of CALs in KD.

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

Cited by 5 publications

References 34 publications

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

Predictive value of albumin for intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients

Expression of oxidative stress and inflammatory indicators for coronary artery disease in Kawasaki disease

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