title: Non-Responders to Intravenous Immunoglobulin and Coronary Artery Dilatation in Kawasaki Disease: Predictive Parameters in Korean Children.
abstract: OBJECTIVE
  In Kawasaki disease (KD), high dose intravenous immunoglobulin (IVIG) significantly lowers the coronary complications. However, some patients either do not respond to initial therapy or develop coronary complications. We aimed to identify the predictive factors for unresponsiveness to initial IVIG therapy and coronary artery dilatation (CAD; defined by Z-score≥2.5) in the acute phase and convalescent phase.
  
  
  METHODS
  A retrospective review was conducted of 703 patients with KD, admitted to Gachon University Gil Medical Center between January 2005 and June 2013. The patients were divided into two groups-IVIG responders vs. non-responders-based on the IVIG treatments, and presence of fever after treatment. Further, these groups were divided into two subgroups based on their CAD.
  
  
  RESULTS
  Among the 703 patients with KD, the rate of non-responders to initial IVIG was 16.8%. Serum total bilirubin, platelet count, and neutrophil proportion were independent predictive parameters of unresponsiveness (p<0.05). CAD was found in 234 patients (33.3%) in the acute phase, and in 32 patients (4.6%) in the convalescent phase. Male gender, fever duration, serum C-reactive protein, and white blood cell count were related to CAD (p<0.05). CAD was detected more frequently in non-responders than in the responders (47.5% vs. 31.5%, p=0.001). Kobayashi, Egami, and Sano scoring systems applied to our study population reflected low sensitivities (28.0-33.9%).
  
  
  CONCLUSIONS
  Several independent parameters were related to unresponsiveness to the initial IVIG or CAD. These parameters might be helpful in establishing more focused and careful monitoring of high-risk KD patients in Korea.
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Bo Young
authors.initials: BY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Dongwan
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Eell
authors.initials: E
authors.lastname: Ryoo
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Sun
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: In-Sang
authors.initials: IS
authors.lastname: Jeon
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Mi-Jin
authors.initials: MJ
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Hann
authors.initials: H
authors.lastname: Tchah
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Deok Young
authors.initials: DY
authors.lastname: Choi
authors.affiliation: Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Na Yeon
authors.initials: NY
authors.lastname: Kim
keywords: Children; Coronary arteries; Intravenous immunoglobulins; Kawasaki disease