title: Immunoglobulin G values before treatment are correlated with the responsiveness to initial intravenous immunoglobulin therapy for Kawasaki disease.
abstract: BACKGROUND
  Low levels of serum immunoglobulin G (IgG) before intravenous immunoglobulin (IVIG) therapy for Kawasaki disease (KD) have been reported as one of the risk factors for coronary artery abnormalities (CAAs). This risk factor needs to be re-evaluated because the dosage of IVIG has changed from 0.2-0.4 g/kg/day for 5 days to a single high dose of 2 g/kg.
  
  
  METHODS
  We reviewed the clinical records of KD patients admitted to our hospital from January 2001 to August 2011. Patients who were given a single high dose of IVIG within 7 days of illness, and who had blood collected for serum immunoglobulin values before treatment, were selected. The serum immunoglobulin levels and coronary artery diameters measured by echocardiogram were transformed to z-scores.
  
  
  RESULTS
  The subjects were 197 KD patients, including 22 IVIG nonresponders and 16 patients with CAAs. Of these, 150 (76%) had a z-score for IgG (IgGz) of ≤0. There were no differences in IgGz values between patients with CAAs and those without CAAs. However, nonresponders had higher IgGz values than responders (median, 25th percentile and 75th percentile: -0.26, -0.83 and 0.34 vs. -0.79, -1.40 and -0.03; p = 0.020). Logistic regression analysis showed that the IgGz value was an independent risk factor for resistance to IVIG (OR 1.36, 95% CI 1.002-1.849; p = 0.048).
  
  
  CONCLUSIONS
  Low IgGz values were not a risk factor for CAAs in this study. However, KD patients with relatively high IgGz values before treatment may have an increased risk of resistance to initial IVIG therapy. © 2014 S. Karger AG, Basel.
authors.affiliation: Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yanagimoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nomura
authors.forename: Kiminori
authors.initials: K
authors.lastname: Masuda
authors.forename: Masako
authors.initials: M
authors.lastname: Hirabayashi
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Morita
authors.forename: Michiko
authors.initials: M
authors.lastname: Yoshishige
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ueno
authors.forename: Taisuke
authors.initials: T
authors.lastname: Eguchi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D007074:Immunoglobulin G / Q000097:blood* / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous