title: Risk stratification in the decision to include prednisolone with intravenous immunoglobulin in primary therapy of Kawasaki disease.
abstract: BACKGROUND
  We reported previously that intravenous immunoglobulin (IVIG) plus prednisolone for initial therapy for Kawasaki disease (KD) prevented coronary artery abnormalities (CAA) more effectively than IVIG alone. However, questions remain as to whether PSL has potential benefit in all KD patients. The present study was designed to explore the possibility of stratified initial therapy including PSL in patients with and without a high predicted risk of being an IVIG nonresponder.
  
  
  METHODS
  We retrospectively analyzed data from KD patients who received IVIG (n = 896) or IVIG + PSL (n = 110) by scoring the likely risk of being an IVIG nonresponder. We compared clinical and coronary outcomes between treatment-defined groups separately for high- and low-risk patients.
  
  
  RESULTS
  Among low-risk patients (score 0-4), clinical and coronary outcomes were similar. Among high-risk patients (score 5 or more), incidences of treatment failure and coronary artery abnormalities until 1-month follow-up were more frequent in the IVIG than in the IVIG + PSL group. Sex- and score point-adjusted odds ratios for IVIG + PSL were 0.17 (95% confidence interval, 0.08-0.39) for treatment failure and 0.27 (95% confidence interval, 0.07-0.85) for coronary artery abnormalities A among high-risk patients.
  
  
  CONCLUSIONS
  IVIG + PSL treatment was associated with improving clinical and coronary outcomes in patients at high risk of being IVIG nonresponders.
authors.affiliation: Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan. torukoba@nifty.com
authors.forename: Tohru
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Inoue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otani
authors.forename: Akihiro
authors.initials: A
authors.lastname: Morikawa
authors.forename: Tomio
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Saji
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Sonobe
authors.forename: Shunichi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Miura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Arakawa
mesh_terms: D000704:Analysis of Variance; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D016015:Logistic Models; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D011239:Prednisolone