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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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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.

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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

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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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Authors and Affiliations

  1. Department of Pediatrics, Osaka Kosei-Nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka, 553-0003, Japan

    Tetsuya Sano

  2. Department of Pediatrics, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka City, Osaka, 560-8565, Japan

    Shunji Kurotobi

  3. Department of Pediatrics, Suita Municipal Hospital, 2-13-20 Katayama-cho, Suita City, Osaka, 564-0082, Japan

    Kouji Matsuzaki

  4. Department of Pediatrics, Mino Municipal Hospital, 5-7-1 Kayano, Mino City, Osaka, 562-8562, Japan

    Takehisa Yamamoto

  5. Department of Pediatrics, Ikeda Municipal Hospital, 3-1-18 Jonan, Ikeda City, Osaka, 563-8510, Japan

    Ichiro Maki

  6. Department of Pediatrics, Itami Municipal Hospital, 1-100 Koyaike, Itami City, Hyogo, 664-8540, Japan

    Kazunori Miki

  7. Department of Pediatrics, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 561-0871, Japan

    Shigetoyo Kogaki & Junichi Hara

Authors
  1. Tetsuya Sano
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  2. Shunji Kurotobi
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  3. Kouji Matsuzaki
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  4. Takehisa Yamamoto
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  5. Ichiro Maki
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  6. Kazunori Miki
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  7. Shigetoyo Kogaki
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  8. Junichi Hara
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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). https://doi.org/10.1007/s00431-006-0223-z

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  • DOI: https://doi.org/10.1007/s00431-006-0223-z

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