title: Fever pattern and C-reactive protein predict response to rescue therapy in Kawasaki disease.
abstract: BACKGROUND
  Evidence to guide rescue therapy in refractory Kawasaki disease (KD) is lacking. The aim of this study was to determine the most important variables in predicting non-response to rescue therapy in refractory KD.
  
  
  METHODS
  We retrospectively analyzed 171 patients diagnosed with refractory KD resistant to initial i.v. immunoglobulin (IVIG). Participants received rescue therapy consisting of IVIG monotherapy or IVIG plus prednisolone. Characteristics and laboratory variables were compared between rescue therapy non-responders and responders. Multivariate logistic regression analysis was performed to determine the independent predictors of non-response to rescue therapy.
  
  
  RESULTS
  Among the 171 participants, 54 (31.6%) were non-responders to rescue therapy. On univariate analysis, fever pattern after initial IVIG, day of illness at rescue therapy, rescue therapy regimen and six laboratory variables (pre-IVIG sodium, C-reactive protein [CRP]; post-IVIG white blood cell count, platelet count, sodium, CRP) were useful in discriminating between non-responders and responders. These nine variables were included in multivariate logistic regression analysis. Persistent fever after initial IVIG (aOR, 2.39; 95%CI: 1.07-5.37) and post-IVIG CRP (aOR, 1.09; 95%CI: 1.02-1.17, per 1 mg/dL increase) were identified as independent predictors of non-response to rescue therapy. IVIG rescue monotherapy (aOR, 3.05; 95%CI: 1.05-8.84) also predicted non-response after adjusting for fever pattern and post-IVIG CRP.
  
  
  CONCLUSIONS
  Persistent fever and elevated CRP after initial IVIG are predictive of non-response to rescue therapy for refractory KD. For patients at high risk of non-response, IVIG plus prednisolone, or even further intensified rescue therapy regimens may be preferable.
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.|Department of Pediatrics, Yaizu City Hospital, Yaizu, Shizuoka, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Nakagama
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Inuzuka
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Taiyu
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shindo
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Shimizu
authors.affiliation: Department of Pediatrics, Yaizu City Hospital, Yaizu, Shizuoka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Inatomi
authors.affiliation: Department of Pediatrics, Ome Municipal General Hospital, Ome, Tokyo, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Department of Pediatrics, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Namai
authors.affiliation: Department of Pediatrics, Chigasaki Municipal Hospital, Chigasaki, Kanagawa, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Saitama, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Takamizawa
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Harita
authors.affiliation: Department of Pediatrics, University of Tokyo, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Oka
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000097:blood / Q000209:etiology*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000150:complications*; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D002097:C-Reactive Protein; D011239:Prednisolone
keywords: C-reactive protein; IVIG; Kawasaki disease; i.v. immunoglobulin; prednisolone