Korean Circulation Journal

  • 제44권5호
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  • Pages.328-335
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  • 2014
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin and Prognosis of Coronary Artery Lesions in Patients with Incomplete Kawasaki Disease

  • Cho, Kee Hyun (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Kang, Soo Jung (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 투고 : 2014.05.15
  • 심사 : 2014.08.26
  • 발행 : 2014.05.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: The prevalence of incomplete Kawasaki disease (iKD) is progressively increasing. We aimed to retrospectively investigate the predictors of intravenous immunoglobulin (IVIG) resistance in iKD patients and compare them with those of IVIG resistance in complete Kawasaki disease (cKD) patients. We also compared the prognosis of coronary artery lesions (CALs) between the IVIG non-responders and responders in both iKD and cKD groups.S ubjects and Methods: A total of 234 cKD and 77 iKD patients were treated with IVIG between February 2009 and April 2012. Among these 311 patients, we reviewed the data of 77 iKD patients and 75 age-matched cKD patients. Results: Patients with iKD having an elevated neutrophil count {percentage of segmented neutrophils (SEG%) ${\geq}79.0$} were at risk of IVIG resistance, while patients with cKD having SEG% ${\geq}79.25$ and serum total bilirubin (TB) ${\geq}0.56mg/dL$ were at risk of IVIG resistance as shown by multivariable logistic regression analysis. Fractional changes of laboratory data before and after IVIG treatment showed that Creactive protein (CRP) and N-terminal B type natriuretic peptide (NT-proBNP) levels were significantly elevated in IVIG non-responders of the iKD group, whereas erythrocyte sedimentation rate was significantly elevated in IVIG non-responders of the cKD group. Among the patients who had CALs at 10 months after the start of illness, the z scores of coronary arteries were higher in IVIG non-responders of the iKD group, when compared with IVIG non-responders of the cKD group. Conclusion: Elevated SEG%, changes in CRP and NT-proBNP levels may help in early detection of IVIG resistance in patients of the iKD group, which may aid in predicting the prognosis of CALs in these patients. Further studies with a larger number of patients are warranted.

키워드

참고문헌

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피인용 문헌

  1. High-Dose Aspirin Is Associated with Anemia and Does Not Confer Benefit to Disease Outcomes in Kawasaki Disease vol.10, pp.12, 2015, https://doi.org/10.1371/journal.pone.0144603
  2. The prognostic role of abnormal liver function in IVIG unresponsiveness in Kawasaki disease: a meta-analysis vol.65, pp.2, 2014, https://doi.org/10.1007/s00011-015-0900-3
  3. Kawasaki disease in Sicily: clinical description and markers of disease severity vol.42, pp.1, 2014, https://doi.org/10.1186/s13052-016-0306-z
  4. A novel model for predicting non‐responsiveness to intravenous immunoglobulins in Kawasaki disease: The Singapore experience vol.55, pp.8, 2014, https://doi.org/10.1111/jpc.14329