Coronary risk factors in Kawasaki disease treated with additional gammaglobulin.
OBJECTIVE
To assess the hypothesis that an additional intravenous gammaglobulin (IVGG) infusion, if administered early, may prevent coronary artery lesions (CAL) in patients with Kawasaki disease (KD) who do not respond to initial IVGG therapy.


METHODS
Forty four KD patients (17 with CAL and 27 without CAL), treated with additional IVGG because of persistent or recrudescent fever after initial IVGG therapy, were studied. Main outcome measures were the presence of CAL by echocardiography and the number of febrile days before and after start of additional IVGG infusion (pre- and post-additional IVGG).


RESULTS
In univariate analyses, risk factors for CAL were the number of febrile days pre-additional IVGG, the number of febrile days post-additional IVGG, the number of days that initial IVGG was divided over, the white blood cell count pre- and post-additional IVGG, and the C reactive protein concentration pre-additional IVGG. In a multivariate analysis, the only independent risk factor was the number of febrile days pre-additional IVGG (> or =10 days; odds ratio 7.86; 95% CI 1.44 to 42.8; p = 0.02).


CONCLUSIONS
Among KD patients with persistent or recrudescent fever after initial IVGG therapy, administration of additional IVGG before the first 10 febrile days was associated with a decreased prevalence of CAL, when compared with the prevalence in those who were retreated later. An additional IVGG infusion, if administered early, may prevent CAL in initial IVGG non-responders.
Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan. miura@as.email.ne.jp
M
M
Miura
H
H
Ohki
T
T
Tsuchihashi
H
H
Yamagishi
Y
Y
Katada
K
K
Yamada
Y
Y
Yamashita
A
A
Sugaya
O
O
Komiyama
H
H
Shiro
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006023:Glycoproteins / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D014361:Trypsin Inhibitors / Q000008:administration & dosage; D005719:gamma-Globulins / Q000008:administration & dosage* / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D006023:Glycoproteins; D016756:Immunoglobulins, Intravenous; D014361:Trypsin Inhibitors; D005719:gamma-Globulins; C028665:urinastatin