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

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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.

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Fig. 1

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Alanine aminotransferase


Aspartate aminotransferase


Body surface area


C-reactive protein


Intravenous gamma-globulin


Left anterior descending coronary artery


Lactate dehydrogenase


Left main coronary artery


Right coronary artery


Standard deviation


Total bilirubin


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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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Correspondence to Tetsuya Sano.

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Sano, T., Kurotobi, S., Matsuzaki, K. et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 166, 131–137 (2007).

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