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European Journal of Pediatrics

, Volume 166, Issue 2, pp 131–137 | Cite as

Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment

  • Tetsuya SanoEmail author
  • Shunji Kurotobi
  • Kouji Matsuzaki
  • Takehisa Yamamoto
  • Ichiro Maki
  • Kazunori Miki
  • Shigetoyo Kogaki
  • Junichi Hara
Original Paper

Abstract

Clinical, laboratory, and echocardiographic data were retrospectively analyzed in 112 patients with acute Kawasaki disease who received high-dose (2 g/kg) intravenous gamma-globulin (IVIG) treatment within 2 days and were compared for those who were responsive and non-responsive to initial IVIG treatment. Coronary arteries adjusted for body surface area (BSA) were evaluated quantitatively by comparison with the mean dimensions for 85 normal control subjects. The incidence of coronary abnormalities was higher in IVIG-non-responsive patients as compared to IVIG-responsive patients (71% versus 5%, p<0.0001). Univariate analysis of pre-IVIG data showed that the neutrophil count and serum levels of C-reactive protein (CRP), total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase, and lactate dehydrogenase (LDH) were significantly higher in IVIG-non-responsive versus responsive patients. Multivariate analysis selected CRP (p=0.009), TB (p<0.001), and AST (p=0.002) as independent predictors of non-responsiveness to initial IVIG treatment. By defining predictive values, patients with at least two of three predictors (CRP≥7.0 mg, TB≥0.9 mg, or AST≥200 IU/L) are considered to be non-responsive to IVIG for acute Kawasaki disease. Alternatively, more intense initial therapy may be a promising therapeutic strategy for patients who are predicted to be IVIG-non-responsive.

Keywords

Kawasaki disease Non-responsiveness to gamma-globulin Prediction Coronary artery lesion Multivariate analysis 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BSA

Body surface area

CRP

C-reactive protein

IVIG

Intravenous gamma-globulin

LAD

Left anterior descending coronary artery

LDH

Lactate dehydrogenase

LMCA

Left main coronary artery

RCA

Right coronary artery

SD

Standard deviation

TB

Total bilirubin

Notes

Acknowledgments

We gratefully acknowledge the contributions of Reiko Yabuta, M.D., Takashi Onodera, M.D., Masaru Iwaki, M.D., and Norihiro Kawakami, M.D., for the acquisition of the clinical data, and Keiko Okada-Kubota, M.D., for the data management and statistical advice.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Tetsuya Sano
    • 1
    Email author
  • Shunji Kurotobi
    • 2
  • Kouji Matsuzaki
    • 3
  • Takehisa Yamamoto
    • 4
  • Ichiro Maki
    • 5
  • Kazunori Miki
    • 6
  • Shigetoyo Kogaki
    • 7
  • Junichi Hara
    • 7
  1. 1.Department of PediatricsOsaka Kosei-Nenkin HospitalOsaka CityJapan
  2. 2.Department of PediatricsToyonaka Municipal HospitalToyonaka CityJapan
  3. 3.Department of PediatricsSuita Municipal HospitalSuita CityJapan
  4. 4.Department of PediatricsMino Municipal HospitalMino CityJapan
  5. 5.Department of PediatricsIkeda Municipal HospitalIkeda CityJapan
  6. 6.Department of PediatricsItami Municipal HospitalItami CityJapan
  7. 7.Department of PediatricsOsaka University, Graduate School of MedicineSuita CityJapan

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