KoreaMed Synapse
 
About Synapse
Overview
Help
Disclaimer
Advanced Search
 
 
   
       Journal List > J Korean Med Sci > v.23(4); Aug 2008
  |    |  Full-text      |    |  
J Korean Med Sci. 2008 Aug;23(4):718-722.
Published online 2008 August 25.  doi: 10.3346/jkms.2008.23.4.718.
Copyright © 2008 The Korean Academy of Medical Sciences
Risk Factors for Failure of Initial Intravenous Immunoglobulin Treatment in Kawasaki Disease
Sungho Cha, Minjeong Yoon, Yongjoo Ahn, Miyoung Han and Kyung-Lim Yoon*
Department of Pediatrics, College of Medicine, Kyunghee University Hospital, Seoul, Korea.
*Department of Pediatrics, East-West Neo Medical Center, Kyunghee University, Seoul, Korea.

Address for correspondence: Sungho Cha, M.D. Department of Pediatrics, Kyunghee University Hospital, 1 Hoeki-dong, Dongdaemun-gu, Seoul 130-702, Korea. Tel: +82.2-958-8303, Fax: +82.2-967-1382, Email: sunghocha@khu.ac.kr
Received December 01, 2006; Accepted December 18, 2007.

Abstract

The aims of this study were to determine the occurrence and variables associated with the initial intravenous immunoglobulin (IVIG) treatment failure in Kawasaki disease (KD) and to categorize differences in clinical characteristics between responders and nonresponders to initial IVIG treatment. Patients were classified into two groups. Group A included 33 patients who received a single dose of IVIG treatment and responded. Group B included 18 patients who received more than two doses of IVIG due to failure of the initial treatment. The mean duration of fever after initial treatment in group B was significantly longer than it was in group A. In group B, we found that higher bilirubin, aspartate aminotransferase (AST), polymorphonuclear cells (PMN) (%), and lower platelet values at baseline were independent predictors of persistent or recurrent fever in patients with KD. Coronary artery abnormalities were found in 8 patients (44.4%) in group B and in two patients (6.1%) in group A. We found that abnormal liver function tests and a lower platelet count at baseline were possible predictors of nonresponders to IVIG in patients with KD. There is a need for a prospective study focused on baseline hepatobiliary parameters.

Keywords: Coronary Aneurysm, Immunoglobulins, Intravenous, Mucocutaneous Lymph Node Syndrome, Treatment Failure.
References
1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178–222.
2. Kawasaki T,Kosaki F,Okawa S,Shigematsu I,Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974;54:271–276.
3. Durongpisitkul K,Gururaj VJ,Park JM,Martin CF. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis of the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995;96:1057–1061.
4. Newburger JW,Takahashi M,Burns JC,Beiser AS,Chung KJ,Duffy CE,Glode MP,Mason WH,Reddy V,Sanders SP,Shulman ST,Wiggins JW,Hicks RV,Fulton DR,Lewis AB,Leung DY,Colton T,Rosen FS,Melish ME. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;315:341–347.
5. Newburger JW,Takahashi M,Beiser AS,Burns JC,Bastian J,Chung KJ,Colan SD,Duffy CE,Fulton DR,Glode MP,Mason WH,Meissner HC,Rowley AH,Shulman ST,Reddy V,Sundel RP,Wiggins JW,Colton T,Melish ME,Rosen FS. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324:1633–1639.
6. Kato H,Ichinose E,Yoshioka F,Takechi T,Matsunaga S,Suzuki K,Rikitake N. Fate of coronary aneurysms in Kawasaki disease: serial coronary angiography and long-term follow-up study. Am J Cardiol 1982;49:1758–1766.
7. Suzuki A,Kamiya T,Kuwahara N,Ono Y,Kohata T,Kimura K,Takamiya M. Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases. Pediatr Cardiol 1986;7:3–9.
8. Sundel RP,Burns JC,Baker A,Beiser AS,Newburger JW. Gamma globulin re-treatment in Kawasaki disease. J Pediatr 1993;123:657–659.
9. Wright DA,Newburger JW,Baker A,Sundel RP. Treatment of immune globulin-resistant Kawasaki disease with pulse doses of corticosteroids. J Pediatr 1996;128:146–149.
10. Morens DM,O'Brien RJ. Kawasaki disease in the United States. J Infect Dis 1978;137:91–93.
11. Arjunan K,Daniels SR,Meyer RA,Schwartz DC,Barron H,Kaplan S. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study. J Am Coll Cardiol 1986;8:1119–1124.
12. Takahashi M,Mason W,Lewis A. Regression of coronary artery aneurysms in patients with Kawasaki syndrome. Circulation 1987;75:387–394.
13. Park YW,Han JW,Park IS,Kim CH,Yun YS,Cha SH,Ma JS,Lee SB,Kim CH,Lee HJ,Tockgo YC. Epidemiologic picture of Kawasaki diseases in Korea, 2000-2002. Pediatr Int 2005;47:382–387.
14. Newburger JW,Taubert KA,Shulman ST,Rowley AH,Gewitz MH,Takahashi M,McCrindle BW. Summary and Abstracts of the Seventh International Kawasaki Disease Symposium: December 4-7, 2001, Hakone, Japan. Pediatr Res 2003;53:153–157.
15. Hashino K,Ishii M,Iemura M,Akagi T,Kato H. Re-treatment for immune globulin-resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int 2001;43:211–217.
16. Burns JC,Capparelli EV,Brown JA,Newburger JW,Glode MP. Intravenous gamma-globulin treatment and retreatment in Kawasaki disease. Pediatr Infect Dis J 1998;17:1144–1148.
17. Fukunishi M,Kikkawa M,Hamana K,Onodera T,Matsuzaki K,Matsumoto Y,Hara J. Prediction of non-responsiveness to intravenous high-dose γ-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 2000;137:172–176.
18. Durongpisitkul K,Soongswang J,Laohaprasitiporn D,Nana A,Prachuabmoh C,Kangkagate C. Immunoglobulin failure and retreatment in Kawasaki disease. Pediatr Cardiol 2003;24:145–148.
19. Wallace CA,French JW,Kahn SJ,Sherry DD. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 2000;105:E78.
20. Newburger JW,Takahashi M,Gerber MA,Gewitz MH,Tani LY,Burns JC,Shulman ST,Bolger AF,Ferrieri P,Baltimore RS,Wilson WR,Baddour LM,Levison ME,Pallasch TJ,Falace DA,Taubert KA. Diagnosis, treatment, and long-term management of Kawasaki disease. A statement for Health Professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747–2771.
21. Koren G,Lavi S,Rose V,Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986;108:388–392.
22. Daniels SR,Specker B,Capannari TE,Schwartz DC,Burke MJ,Kaplan S. Correlates of coronary artery aneurysm formation in patients with Kawasaki disease. Am J Dis Child 1987;141:205–207.
23. Mori M,Imagawa T,Yasui K,Kanaya A,Yokota S. Predictors of coronary artery lesions after intravenous γ-globulin treatment in Kawasaki disease. J Pediatr 2000;137:177–180.
24. Burns JC,Glode MP,Clarke SH,Wiggins J Jr,Hathaway WE. Coagulopathy and platelet activation in Kawasaki syndrome: Identification of patients at high risk for development of coronary artery aneurysms. J Pediatr 1984;105:206–211.
25. Lang BA,Silverman ED,Laxer RM,Rose V,Nelson DI,Rubin LA. Serum-soluble interleukin-2 receptor levels in Kawasaki disease. J Pediatr 1990;116:592–596.
26. Lin CY,Lin CC,Hwang B,Chiang BN. The changes of interleukin-2, tumor necrotic factor and gamma-interferon production among patients with Kawasaki disease. Eur J Pediatr 1991;150:179–182.
27. Burns JC,Mason WH,Glode MP,Shulman ST,Melish ME,Meissner C,Bastian J,Beiser AS,Meyerson HM,Newburger JW. Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. J Pediatr 1991;118:680–686.
28. Uehara R,Yashiro M,Hayasaka S,Oki I,Nakamura Y,Muta H,Ishii M,Matsuishi T,Sonobe T,Yanagawa H. Serum alanine aminotransferase concentrations in patients with Kawasaki disease. Pediatr Infect Dis J 2003;22:839–842.
29. Lee GB,Lee JW,Lee KY. Prediction of intravenous immunoglobulin non-responders in patients with Kawasaki disease. Korean J Pediatr 2004;47:90–94.
30. Kobayashi T,Inoue Y,Takeuchi K,Okada Y,Tamura K,Tomomasa T,Kobayashi T,Morikawa A. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606–2612.