Risk stratification in the decision to include prednisolone with intravenous immunoglobulin in primary therapy of Kawasaki disease.
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.
Kobayashi
Tohru
T
Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan. torukoba@nifty.com
Inoue
Yoshinari
Y
Otani
Tetsuya
T
Morikawa
Akihiro
A
Kobayashi
Tomio
T
Takeuchi
Kazuo
K
Saji
Tsutomu
T
Sonobe
Tomoyoshi
T
Ogawa
Shunichi
S
Miura
Masaru
M
Arakawa
Hirokazu
H
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
D016756:Immunoglobulins, Intravenous; D011239:Prednisolone