Predictors of coronary artery lesions after intravenous gamma-globulin treatment in Kawasaki disease.

Abstract

OBJECTIVE:

We evaluated the efficacy of intravenous gamma-globulin (IVGG) administration for children with Kawasaki disease to establish whether additional, more advanced therapy is needed in intractable cases.

STUDY DESIGN:

A total of 193 children with Kawasaki disease were studied retrospectively. Patients were admitted 3 to 7 days after the onset of the disease, and IVGG was administered. Laboratory measurements including white blood cell (WBC), neutrophil, and platelet counts and C-reactive protein (CRP) and albumin concentrations were determined before and 2 to 3 days after IVGG treatment. The progression of coronary artery lesions (CALs) was monitored by serial echocardiography until 30 days after treatment.

RESULTS:

Of 193 children, 24 (12.2 %) had CALs including transient dilatation. In contrast to the other measurements, the WBC count increased in 21 of 24 (87.5%) children with CALs after IVGG therapy. The patients with increased neutrophil count and CRP concentration after IVGG therapy also had CAL formation at a high rate (78.3% and 66.7%, respectively). Among children with normal coronary arteries, elevations of the WBC and neutrophil counts and CRP concentration were observed after IVGG therapy in only 3, 6, and 8 patients, respectively (specificity: 98.2%, 97.0%, and 95.3%, respectively). Furthermore, multiple logistic regression indicated that these variables were useful predictors of CALs in KD.

CONCLUSION:

Though the introduction of IVGG therapy has improved the prognosis of Kawasaki disease, approximately 10% of patients still develop CALs. The need for more aggressive therapy in IVGG-resistant cases can be recognized early by increases in the WBC and neutrophil counts and serum CRP concentration after IVGG administration.

• Authors: M Mori, T Imagawa, K Yasui, A Kanaya, S Yokota
• Journal: The Journal of pediatrics (J Pediatr) Vol. 137 Issue 2 Pg. 177-80 (Aug 2000) ISSN: 0022-3476 [Print] United States
• PMID: 10931408 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Immunoglobulins, Intravenous
• Serum Albumin
• C-Reactive Protein

Topics

• Biomarkers (blood)
• Blood Cell Count
• C-Reactive Protein (metabolism)
• Child
• Child, Preschool
• Coronary Disease (etiology, prevention & control)
• Female
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Infant
• Male
• Mucocutaneous Lymph Node Syndrome (complications, therapy)
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Serum Albumin (metabolism)