title: Prediction of Resistance to Intravenous Immunoglobulin in Children With Kawasaki Disease.
abstract: BACKGROUND
  Approximately 10%-20% of patients with Kawasaki disease (KD) are refractory to initial intravenous immunoglobulin (IVIg) therapy, and these "nonresponders" are at higher risk of coronary artery abnormalities. Early identification of these patients, who may benefit from additional therapy, is challenging. The aim of the present study is to identify predictors for IVIg resistance.
  
  
  METHODS
  We reviewed clinical records of 312 consecutive KD patients from 9 medical centers in Israel (development dataset) and 186 patients from additional 5 centers (validation dataset). Using multivariate analysis, we identified predictors of IVIg resistance. A third small prospective cohort of consecutive KD patients from a single medical center was used to test the accuracy of the predictors.
  
  
  RESULTS
  Coronary artery abnormalities in the initial echocardiogram and presenting before day 5 of fever were independent predictors of IVIg nonresponse. Using either of these variables generated an area under the receiver-operating-characteristics curve of 0.7 (95% confidence interval [CI], 0.6-0.8). Sensitivity to predict nonresponse was 81% (95% CI, 67-90) and specificity was 50% (95% CI, 44-56). Similar results were found in the validation dataset and in the small prospective cohort.
  
  
  CONCLUSIONS
  Coronary artery abnormalities in the initial echocardiogram and presenting before day 5 of fever show high sensitivity in identifying IVIg nonresponders among our KD patients.
authors.affiliation: Pediatrics and Infectious Diseases Division, Shaare-Zedek Medical Center, Jerusalem, Israel.|Faculty of Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Maskit
authors.initials: M
authors.lastname: Bar-Meir
authors.affiliation: Pediatrics and Infectious Diseases Division, Shaare-Zedek Medical Center, Jerusalem, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Kalisky
authors.affiliation: Pediatrics and Pediatric Infectious Diseases, Wolfson Medical Center, Holon, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Schwartz
authors.affiliation: Pediatrics and Pediatric Infectious Diseases, Wolfson Medical Center, Holon, Israel.|Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Somekh
authors.affiliation: Pediatrics and Pediatric Infectious Diseases, Wolfson Medical Center, Holon, Israel.|Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Tasher
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous