Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease.
OBJECTIVE
The objective of this study was to find the predictors and generate a prediction score of resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD).


METHODS
Patients diagnosed as having KD were sampled when they received initial high-dose IVIG treatment (2 g/kg dose) within 9 days of illness (n = 320). These patients were divided into 2 groups: the resistance (n = 41) and the responder (n = 279). The following data were obtained and compared between resistance and responder: age, sex, illness days at initial treatment, and laboratory data.


RESULTS
Multivariate logistic regression analysis identified age, illness days, platelet count, alanine aminotransferase (ALT), and C-reactive protein (CRP) as significant predictors for resistance to IVIG. We generated prediction score assigning 1 point for (1) infants less than 6 months old, (2) before 4 days of illness, (3) platelet count <or= 30 x 10(10)/L, (4) CRP >or= 8 mg/dL, as well as 2 points for (5) ALT >or= 80 IU/L. Using a cut-off point of 3 and more with this prediction score, we could identify the IVIG-resistant group with 78% sensitivity and 76% specificity.


CONCLUSIONS
Resistance to IVIG treatment can be predicted using age, illness days, platelet count, ALT, and CRP. Randomized, multicenter clinical trials are necessary to create a new strategy to treat these high-risk patients.
Egami
Kimiyasu
K
Department of Pediatrics, Kurume University, Kurume, Japan.
Muta
Hiromi
H
Ishii
Masahiro
M
Suda
Kenji
K
Sugahara
Yoko
Y
Iemura
Motofumi
M
Matsuishi
Toyojiro
T
D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood; D001792:Blood Platelets; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
D016756:Immunoglobulins, Intravenous; D000410:Alanine Transaminase