Heart Rate, Responsiveness to Intravenous Immunoglobulin, and Coronary Artery Aneurysms in Kawasaki Disease

Miyakoshi, Chisato; Yamamoto, Yosuke; Yamakawa, Masaru; Fukuhara, Shunichi

doi:10.1016/j.jpeds.2018.04.036

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…However, 73 studies were excluded by reading the complete researches due to article type (n = 18), using the modified IVIG dosing as the initial treatment (n = 7), and lacking specific numbers of CAL cases in KD patients with IVIG resistance or response (n = 48). Ultimately, 53 articles [8,10,11,13, were included in the meta-analysis. The kappa test showed the kappa value of agreement during the systematic searches was 0.86.…”

Section: Search Resultsmentioning

confidence: 99%

“…IVIG resistance is one of the dominant adverse effects during acute phase treatment, which brought into observations. Even several previous studies [7][8][9] have suggested that the incidence of CAL was significantly higher in IVIG resistant populations. However, this issue still be debating as a series of researches demonstrated the negative association between IVIG resistance and CAL.…”

Section: Plos Onementioning

confidence: 88%

“…However, up to 20% of KD patients may fail to respond to IVIG [6]. Even though the precise molecular mechanism of CAL and IVIG in KD are still unclear, many clinical studies suggest IVIG resistance has deeply associated with the occurrence of CAL [7][8][9]. Thus, a great deal of literature have used this as a starting point to study the indicators for predicting IVIG resistance [10][11][12][13], with the expectation that additional therapeutic measures can be taken to reduce the incidence of CAL through early diagnosis of IVIG resistance.…”

Section: Introductionmentioning

confidence: 99%

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Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis

Zheng

Peng

et al. 2021

PLoS ONE

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Background Coronary artery lesion (CAL) caused by Kawasaki disease (KD) is a leading cause of acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAL. Although most of the current studies have shown a certain correlation between CAL and IVIG resistance, the conclusions are not completely consistent. Thus, we performed this meta-analysis to evaluate the association between IVIG resistance and CAL in KD. Methods PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through April 21, 2020 were searched to detect relevant studies. Data analysis was performed with STATA 15.1. Results A total of 53 relevant studies were eligible to this analysis, including 30312 KD patients, of which 4750 were IVIG resistance and 25562 were responders. There was a significant difference found between IVIG resistance and IVIG response groups in the incidence of CAL (P < 0.001, odds ratio (OR), 3.89; 95% confidence interval (CI) (3.18, 4.75)). The heterogeneity test results showed that the I2 value was 74.8%. The meta-regression analysis showed that the study regions might be the sources of heterogeneity. The subgroup analysis suggested that the incidence of CAL in the IVIG resistance group was still higher than that in the IVIG response group under different regions, IVIG resistance diagnostic criteria, CAL diagnostic criteria, and study types. Meanwhile, the sensitivity analysis did not find any significant impact from every single study. Conclusions This is the first meta-analysis to reveal the incidence of CAL was associated with IVIG resistance in KD patients. Further well-designed studies with uniform criteria are needed to evaluate the incidence of CAL in IVIG resistant patients.

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Section: Search Resultsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis

Zheng

Peng

et al. 2021

PLoS ONE

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“…However, this initial IVIG option fails to work in more than 10% of children, so determining a method for predicting unresponsiveness to this treatment is crucial. 5,6 KD leads to coronary artery aneurysms in approximately 25% of untreated children but only 3e5% of those who receive IVIG treatment and is the primary cause of acquired heart disease in children in developed countries. 7e9 Before the real cause can be determined, KD mimics the symptoms of other infectious diseases and always includes a fever that lasts for at least 5 days, 1 which often results in the use of one or more antibiotics to treat the assumed infections or other diagnosed infectious diseases before KD is properly identified.…”

Section: Introductionmentioning

confidence: 99%

Multiple intravenous antibiotics usage is associated with intravenous immunoglobulin resistance in Kawasaki disease

Lee

Chu

et al. 2022

Pediatrics & Neonatology

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Background: Kawasaki disease (KD) is a form of systemic vasculitis that primarily affects children under the age of 5 years old. Antibiotics are often prescribed for KD patients even before a diagnosis is made due to their prolonged fever and elevated inflammatory markers. Therefore, the purpose of this study was to investigate the impact of antibiotics usage on the disease outcome of KD. Methods: We carried out a retrospective chart review of children between 2005 and 2017 for initial immunoglobulin (IVIG) treatment of KD. KD children with initial IVIG treatment more than 10 days after the onset of symptoms were excluded. Results: In total, 280 children were eligible for this study, among which 209 had been treated with antibiotic(s) and 71 had not been. The IVIG resistance rates were 5.6% (4/71), 8.9% (10/ 112), and 21.6% (21/97) in non-users, single-drug users, and multiple-drug users, respectively (r Z 0.205, p Z 0.003). The IVIG resistance rate of the multiple antibiotics drug users in KD patients was significantly higher than the other two groups. Furthermore, the likelihood of IVIG resistance was found to increase with elevated C-reactive protein (CRP) values (1.010/unit, p < 0.001) but not with total white blood cell (WBC) count (p Z 0.466).

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“…Risk factors for persistent CAA include long duration of fever and failure to respond to initial IVIG therapy, which manifests as persistent abnormal laboratory findings. These abnormal findings include low hemoglobin (Hb), low serum albumin, and low serum sodium (i.e., < 135 mEq/L) levels, an elevated heart rate, elevated alanine aminotransferase (ALT), elevated C-reactive protein (CRP), an elevated erythrocyte sedimentation rate (ESR), and elevated white blood cell (WBC) count (14)(15)(16)(17)(18)(19). However, no studies have reported a correlation between M. pneumoniae and CAA.…”

Section: Introductionmentioning

confidence: 99%

Association between Mycoplasma pneumoniae Infection and Coronary Artery Aneurysm in Children with Kawasaki Disease

et al. 2020

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Background: The epidemiology of Kawasaki disease (KD) suggests that an infectious agent may be a potential disease trigger in susceptible children. Several studies have shown that the cause of KD may be associated with Mycoplasma pneumoniae (M. pneumoniae) infection. Objectives: We aimed to investigate the relationship between M. pneumoniae infection and coronary artery aneurysm (CAA) in children with KD in China. Methods: From January 2015 to December 2018, a total of 330 children with KD met the inclusion criteria. Relevant data were extracted and analysed. Results: The children were stratified into two groups according to M. pneumoniae infection status. Significant differences were identified in the proportion of patients with fever > 10 days, the occurrence of small CAA, and the average serum sodium, pre-albumin (PA), and albumin levels but not in the occurrence of medium and giant CAA between the two groups. According to binary logistic regression, M. pneumoniae infection (OR: 0.515; 95% CI: 0.309 - 0.860; P = 0.011), serum sodium levels (OR: 0.910; 95% CI: 0.851 - 0.972; P =0.005), and PA (OR: 0.900; 95% CI: 0.854 - 0.949; P ≤ 0.001) levels were independently associated with occurrence of small CAA. Conclusions: We demonstrated that M. pneumoniae infection, serum sodium and PA levels are inversely related to the occurrence of small CAA. These results suggest that M. pneumoniae infection may be associated with a decreased incidence of small CAA. Further large-sample studies are needed.

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Heart Rate, Responsiveness to Intravenous Immunoglobulin, and Coronary Artery Aneurysms in Kawasaki Disease

Cited by 4 publications

References 22 publications

Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis

Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis

Multiple intravenous antibiotics usage is associated with intravenous immunoglobulin resistance in Kawasaki disease

Association between Mycoplasma pneumoniae Infection and Coronary Artery Aneurysm in Children with Kawasaki Disease

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