Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Non-Responders to Intravenous Immunoglobulin and Coronary Artery Dilatation in Kawasaki Disease: Predictive Parameters in Korean Children

  • Kim, Bo Young (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Kim, Dongwan (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Kim, Yong Hyun (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Ryoo, Eell (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Sun, Yong Han (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Jeon, In-sang (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Jung, Mi-Jin (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Cho, Hye Kyung (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Tchah, Hann (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Choi, Deok Young (Department of Pediatrics, Gachon University Gil Medical Center) ;
  • Kim, Na Yeon (Department of Pediatrics, Gachon University Gil Medical Center)
  • Received : 2015.08.13
  • Accepted : 2015.10.27
  • Published : 2016.07.30
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Abstract

Background and Objectives: In Kawasaki disease (KD), high dose intravenous immunoglobulin (IVIG) significantly lowers the coronary complications. However, some patients either do not respond to initial therapy or develop coronary complications. We aimed to identify the predictive factors for unresponsiveness to initial IVIG therapy and coronary artery dilatation (CAD; defined by Z-score${\geq}2.5$) in the acute phase and convalescent phase. Subjects and Methods: A retrospective review was conducted of 703 patients with KD, admitted to Gachon University Gil Medical Center between January 2005 and June 2013. The patients were divided into two groups-IVIG responders vs. non-responders-based on the IVIG treatments, and presence of fever after treatment. Further, these groups were divided into two subgroups based on their CAD. Results: Among the 703 patients with KD, the rate of non-responders to initial IVIG was 16.8%. Serum total bilirubin, platelet count, and neutrophil proportion were independent predictive parameters of unresponsiveness (p<0.05). CAD was found in 234 patients (33.3%) in the acute phase, and in 32 patients (4.6%) in the convalescent phase. Male gender, fever duration, serum C-reactive protein, and white blood cell count were related to CAD (p<0.05). CAD was detected more frequently in non-responders than in the responders (47.5% vs. 31.5%, p=0.001). Kobayashi, Egami, and Sano scoring systems applied to our study population reflected low sensitivities (28.0-33.9%). Conclusion: Several independent parameters were related to unresponsiveness to the initial IVIG or CAD. These parameters might be helpful in establishing more focused and careful monitoring of high-risk KD patients in Korea.

Keywords

References

  1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178-222.
  2. Burns JC, Capparelli EV, Brown JA, Newburger JW, Glode MP. Intravenous gamma-globulin treatment and retreatment in Kawasaki disease US/Canadian Kawasaki Syndrome study group. Pediatr Infect Dis J 1998;17:1144-8. https://doi.org/10.1097/00006454-199812000-00009
  3. Wallace CA, French JW, Kahn SJ, Sherry DD. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 2000;105:E78. https://doi.org/10.1542/peds.105.6.e78
  4. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986;108:388-92. https://doi.org/10.1016/S0022-3476(86)80878-2
  5. Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  6. Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006;149:237-40. https://doi.org/10.1016/j.jpeds.2006.03.050
  7. 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 2007;166:131-7.
  8. Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011;24:60-74. https://doi.org/10.1016/j.echo.2010.10.004
  9. Manlhiot C, Millar K, Golding F, McCrindle BW. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 2010;31:242-9. https://doi.org/10.1007/s00246-009-9599-7
  10. Kim GB, Han JW, Park YW, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. Pediatr Infect Dis J 2014;33:24-7. https://doi.org/10.1097/INF.0000000000000010
  11. Matsubara T, Ichiyama T, Furukawa S. Immunological profile of peripheral blood lymphocytes and monocytes/macrophages in Kawasaki disease. Clin Exp Immunol 2005;141:381-7. https://doi.org/10.1111/j.1365-2249.2005.02821.x
  12. Tremoulet AH, Best BM, Song S, et al. Resistance to intravenous immunoglobulin in children with Kawasaki disease. J Pediatr 2008;153:117-21. https://doi.org/10.1016/j.jpeds.2007.12.021
  13. Ashouri N, Takahashi M, Dorey F, Mason W. Risk factors for nonresponse to therapy in Kawasaki disease. J Pediatr 2008;153:365-8. https://doi.org/10.1016/j.jpeds.2008.03.014
  14. Fu PP, Du ZD, Pan YS. Novel predictors of intravenous immunoglobulin resistance in Chinese children with Kawasaki disease. Pediatr Infect Dis J 2013;32:319-23.
  15. Cha S, Yoon M, Ahn Y, Han M, Yoon KL. Risk factors for failure of initial intravenous immunoglobulin treatment in Kawasaki disease. J Korean Med Sci 2008;23:718-22. https://doi.org/10.3346/jkms.2008.23.4.718
  16. Do YS, Kim KW, Chun JK, Cha BH, Namgoong MK, Lee HY. Predicting factors for refractory Kawasaki disease. Korean Circ J 2010;40:239-42. https://doi.org/10.4070/kcj.2010.40.5.239
  17. Park HM, Lee DW, Hyun MC, Lee SB. Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease. Korean J Pediatr 2013;56:75-9. https://doi.org/10.3345/kjp.2013.56.2.75
  18. Sleeper LA, Minich LL, McCrindle BM, et al. Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance. J Pediatr 2011;269:831-5.e3.
  19. Choi MH, Park CS, Kim DS, Kim KH. Prediction of intravenous immunoglobulin nonresponse Kawasaki disease in Korea. Korean J Pediatr Infect Dis 2014;21:29-36.
  20. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  21. Cho KH, Kang SJ. Clinically useful predictors of resistance to intravenous immunoglobulin and prognosis of coronary artery lesions in patients with incomplete Kawasaki disease. Korean Cir J 2014;44:328-35. https://doi.org/10.4070/kcj.2014.44.5.328
  22. Hashino K, Ishii M, Iemura M, Akagi T, Kato H. Re-treatment for immune globulin-resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int 2001;43:211-7. https://doi.org/10.1046/j.1442-200x.2001.01373.x
  23. Beiser AS, Takahashi M, Baker AL, Sundel RP, Newburger JW. A predictive instrument for coronary artery aneurysms in Kawasaki disease. US Multicenter Kawasaki Disease Study Group. Am J Cardiol 1998;81:1116-20. https://doi.org/10.1016/S0002-9149(98)00116-7
  24. Honkanen VE, McCrindle BW, Laxer RM, Feldman BM, Schneider R, Silverman ED. Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cardiol 2003;24:122-6. https://doi.org/10.1007/s00246-002-0063-1
  25. Gersony WM. Predicting coronary aneurysms in Kawasaki disease. Am J Cardiol 1998;81:1162-4. https://doi.org/10.1016/S0002-9149(98)00115-5
  26. Park MJ, Jeon IS, Tchah H, Cho KH, Jung MJ, Choi DY. Predictive indicators of coronary artery complications in Kawasaki disease. Korean J Pediatr 2009;52:1161-6. https://doi.org/10.3345/kjp.2009.52.10.1161
  27. Singh S, Aulakh R, Kawasaki T. Kawasaki disease and the emerging coronary artery disease epidemic in India: is there a correlation? Indian J Pediatr 2014;81:328-32. https://doi.org/10.1007/s12098-013-1229-y
  28. Kawai H, Takakuwa Y, Naruse H, et al. Two cases with past Kawasaki disease developing acute myocardial infarction in their thirties, despite being regarded as at low risk for coronary events. Heart Vessels 2014;30:549-53.
  29. Ogata S, Ogihara Y, Honda T, Kon S, Akiyama K, Ishii M. Corticosteroid pulse combination therapy for refractory Kawasaki disease: a randomized trial. Pediatrics 2012;129:e17-23. https://doi.org/10.1542/peds.2011-0148
  30. Chen S, Dong Y, Yin Y, Krucoff MW. Intravenous immunoglobulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis. Heart 2013;99:76-82. https://doi.org/10.1136/heartjnl-2012-302126

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