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Early Appearance of Principal Symptoms of Kawasaki Disease is a Risk Factor for Intravenous Immunoglobulin Resistance.

Abstract
It is difficult to accurately predict treatment resistance in Kawasaki disease (KD). Patients considered to be low-risk cases often develop resistance to intravenous immunoglobulin (IVIG). We herein examined whether information from the clinical course of KD could improve the prediction accuracy of a previously reported risk score. We retrospectively reviewed the clinical records of 100 KD patients. The clinical characteristics and laboratory data were compared between IVIG-sensitive and IVIG-resistant patients and also between patients with and without coronary artery aneurysm (CAA). The total incidence of IVIG resistance and CAA development was 34 and 13 %, respectively. Multiple regression analysis identified the early appearance of principal symptoms (≤day 2 of the illness) as a risk factor for IVIG resistance (OR 2.88, 95 % CI 1.11-7.44, p = 0.0041), whereas delayed IVIG administration (≥day 6) (OR 2.23, 95 % CI 0.66-7.64, p = 0.018) and IVIG resistance (OR 9.05, 95 % CI 2.27-36.10, p = 0.015) were independent predictors for CAA development. The addition of the first appearance day of principal symptoms into a previously reported scoring system improved its prediction accuracy for IVIG resistance. KD patients who had presented with any principal symptoms within 2 days of fever onset were at a high risk for IVIG resistance regardless of previously reported risk score. A careful medical history-taking that is focused on the clinical course enables a better prediction of IVIG resistance.
AuthorsMiyu Tajima, Yusuke Shiozawa, Jiro Kagawa
JournalPediatric cardiology (Pediatr Cardiol) Vol. 36 Issue 6 Pg. 1159-65 (Aug 2015) ISSN: 1432-1971 [Electronic] United States
PMID25753685 (Publication Type: Journal Article)
Chemical References
  • Immunoglobulins, Intravenous
Topics
  • Child
  • Child, Preschool
  • Coronary Aneurysm (epidemiology, etiology, prevention & control)
  • Drug Resistance
  • Early Diagnosis
  • Female
  • Fever (physiopathology)
  • Humans
  • Immunoglobulins, Intravenous (administration & dosage, therapeutic use)
  • Male
  • Mucocutaneous Lymph Node Syndrome (complications, drug therapy)
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

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