title: Predicting IVIG resistance in UK Kawasaki disease.
abstract: The Kobayashi score (KS) predicts intravenous immunoglobulin (IVIG) resistance in Japanese children with Kawasaki disease (KD) and has been used to select patients for early corticosteroid treatment. We tested the ability of the KS to predict IVIG resistance and coronary artery abnormalities (CAA) in 78 children treated for KD in our UK centre. 19/59 children were IVIG non-responsive. This was not predicted by a high KS (11/19 IVIG non-responders, compared with 26/40 responders, had a score ≥4; p=0.77). CAA were not predicted by KS (12/20 children with CAA vs 25/39 with normal echo had a score ≥4; p=0.78). Low albumin and haemoglobin, and high C-reactive protein were significantly associated with CAA. The KS does not predict IVIG resistance or CAA in our population. This highlights the need for biomarkers to identify children at increased risk of CAA, and to select patients for anti-inflammatory treatment in addition to IVIG.
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors: Sarah
authors: S
authors: Davies
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors: Natalina
authors: N
authors: Sutton
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors: Sarah
authors: S
authors: Blackstock
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK Section of Paediatrics, Imperial College London, London, UK.
authors: Stuart
authors: S
authors: Gormley
authors: Department of Genomics of Common Disease, Imperial College London, London, UK.
authors: Clive J
authors: CJ
authors: Hoggart
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK Section of Paediatrics, Imperial College London, London, UK.
authors: Michael
authors: M
authors: Levin
authors: Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK Section of Paediatrics, Imperial College London, London, UK.
authors: Jethro A
authors: http://orcid.org/0000-0001-6941-6491
authors: JA
authors: Herberg
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology / Q000517:prevention & control*; D004351:Drug Resistance; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: IVIG-resistant; Kawasaki Disease; Kobayashi Score; prediction