Prediction of intravenous immunoglobulin resistance in patients with Kawasaki disease according to the duration of illness prior to treatment

  • Kee-Soo Ha
  • JungHwa LeeEmail author
  • Kwang Chul Lee
Original Article


Risk factors predicting intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) were assessed according to the duration of illness prior to treatment. Of 555 KD patients included between 2008 and 2014, 362 were IVIG responders (65.2%) and 193 were IVIG non-responders (34.8%). The risk of IVIG resistance was inversely correlated with the duration of illness prior to treatment. Neutrophil dominance (≥  80%) was significantly higher in IVIG non-responders regardless of the duration of pre-IVIG illness. While there were no differences between IVIG responders and non-responders who were diagnosed at < 3 days, increasing platelet count and decreasing liver enzyme levels were seen over time in IVIG responders, but not in IVIG non-responders. Multivariable analysis showed that, in addition to neutrophil levels ≥  80%, risk factors for IVIG resistance were age ≤  12 months for patients who were diagnosed at ≤  3 days, and platelet count ≤  300 × 103/μL and aspartate aminotransferase level ≥  100 IU/L for patients who were diagnosed at ≥  6 days.

Conclusion: Predictors of IVIG resistance in patients with KD differ according to the duration of pre-treatment illness. Risk assessment according to the duration of illness may improve the prediction of IVIG resistance.

What is Known:

Several systems have been developed to predict IVIG resistance in patients with KD but the sensitivity and specificity of these tools are insufficient and ethnic variations have been reported.

What is New:

Predictors of IVIG resistance differ depending on the duration of illness prior to treatment.

Risk assessment according to the duration of pre-treatment illness may improve the ability to predict IVIG resistance.


Intravenous immunoglobulin Kawasaki disease Resistance Risk factor 



Alanine aminotransferase


Aspartate aminotransferase


Coronary artery abnormalities


Coronary artery aneurysm


Coronary artery dilatation


Confidence interval


C-reactive protein


Intravenous immunoglobulin


Kawasaki disease


Odds ratio



We thank Dr. Soon-Young Hwang (Biostatistical consulting unit, Medical Science Research Center, College of Medicine, Korea University) for statistical assistance.

Authors’ Contributions

KSH, KCL and JL designed the study, and collected and analyzed the data. JL drafted the initial and final manuscript. All authors participated in critical review and approved the final manuscript as submitted.

Compliance with ethical statements

Conflict of interest

The authors have no conflicts of interest to disclose.

Informed consent

This study is a retrospective and observational study and does not contain any studies with human participants or animals. With the approval of the institutional review board of the Korea University Medical Center, no informed consent was asked.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Guro HospitalKorea University Medical CenterSeoulRepublic of Korea
  2. 2.Department of Pediatrics, Anam HospitalKorea University Medical CenterSeoulRepublic of Korea

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