title: Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients.
abstract: OBJECTIVE
  Kawasaki disease (KD) is an acute systemic vasculitis. Activation of the immune system is a central feature of KD. Some KD patients are resistant to initial high-dose intravenous immunoglobulin (IVIG) treatment. The study aimed to determine the predictors of IVIG resistance.
  
  
  METHODS
  A single-center, retrospective study was conducted using data from 129 patients diagnosed with KD. Two groups of patients emerged within the IVIG-treated population (105 patients): an IVIG responder group (n = 84) and an IVIG-resistant group (n = 21). Laboratory data and patient characteristics were compared between the two groups.
  
  
  RESULTS
  The average serum interleukin (IL)-6 level was 102.7 ± 97.4 pg/mL in the IVIG responder group and 207.7 ± 127.1 pg/mL in the IVIG resistant group (P < 0.01). C-reactive protein (CRP) levels and neutrophil percentages were significantly elevated in the IVIG resistant group. Multivariate logistic regression analysis identified that a prediction score could be generated by assigning two points to neutrophil percentages ≥ 75%, and either two points for an IL-6 level ≥ 140 pg/mL or one point for an IL-6 level ≥ 70 pg/mL but < 140 pg/mL. A cut-off score of ≥ three allowed identification of IVIG-resistant patients with an 85% sensitivity and 77% specificity.
  
  
  CONCLUSIONS
  Resistance to IVIG therapy is characterized by elevated levels of IL-6, CRP and percentages of circulating neutrophils. Resistance to IVIG treatment can be predicted using a scoring system involving IL-6 and percentages of neutrophils.
authors.affiliation: Department of Pediatrics, Tokyo Medical University, Tokyo, Japan. sato115@tokyo-med.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sato
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawashima
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Kashiwagi
authors.forename: Akinori
authors.initials: A
authors.lastname: Hoshika
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D007564:Japan; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015999:Multivariate Analysis; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D016207:Cytokines; C508600:IL6 protein, human; D016756:Immunoglobulins, Intravenous; D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein