Non-Responders to Intravenous Immunoglobulin and Coronary Artery Dilatation in Kawasaki Disease: Predictive Parameters in Korean Children

Kim, Bo Young; Kim, Dong-Wan; Kim, Yong Hyun; Ryoo, Eell; Sun, Yong Han; Jeon, In Sang; Jung, Mi; Cho, Hye‐Kyung; Tchah, Hann; Choi, Do Il; Kim, Na Yeon

doi:10.4070/kcj.2016.46.4.542

Cited by 31 publications

(23 citation statements)

References 30 publications

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“…In future research, we will use the Z value to further verify these findings. In addition, CRP [45], WBC [46], PLT [47], hemoglobin [48], albumin [49], and total bilirubin [50] have been reported as risk factors for coronary artery damage. Further studies are needed to investigate the superiority of low-AAR compared to the above mentioned risk factors.…”

Section: Discussionmentioning

confidence: 99%

Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease

Ren

Shi

et al. 2020

Cardiology Research and Practice

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Objective. To investigate the association between the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT ratio, AAR) and intravenous immunoglobulin (IVIG) resistance, coronary artery lesions (CAL), and coronary artery aneurysms (CAA) in children with Kawasaki disease (KD). Design. We retrospectively studied 2678 children with KD and divided them into two groups: a low-AAR group and a high-AAR group with a median AAR of 1.13 as the cut-off point. The differences in laboratory data, clinical manifestations, and coronary artery damage rates were compared between the two groups. Results. The incidence of CAL was higher in the low-AAR group than in the high-AAR group at 2 and 3-4 weeks after illness onset (p<0.001, respectively). The IVIG resistance rate was significantly higher in the low-AAR group than in the high-AAR group (29.94% vs 21.71%, p<0.001). The levels of C-reactive protein, erythrocyte sedimentation rate, white blood cell count, bilirubin, fibrinogen, thrombin time, D-dimer, and brain natriuretic peptide were also significantly higher in the low-AAR group compared with the high-AAR group. The levels of albumin and IgG were significantly lower in the low-AAR group compared with those of the high-AAR group. The proportion of typical KD cases in the low-AAR group was significantly higher than that in the high-AAR group. Low-AAR correlated with the risk of coronary artery damage and IVIG resistance. Conclusion. Children with KD who had low-AAR value were more likely to develop coronary artery damage and IVIG resistance. Low AAR is a risk factor for CAL, CAA, and IVIG resistance in KD.

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Section: Discussionmentioning

confidence: 99%

Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease

Ren

Shi

et al. 2020

Cardiology Research and Practice

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“…The results of 20 studies were combined in this study comprising 18 Asian studies [4, 6, 9, 10, 13, 17, 19, 20, 22, 24–26, 29, 32, 33, 37, 41, 44] and 2 North American studies [18, 38]. Each subgroup analysis showed the results had statistical significance; however, Baek et al [2] reported that ESR and platelet count could not predict IVIG-resistant Kawasaki disease from their statistical meta-analysis, which is contrary to the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a meta-analysis of 4442 cases

Chen

Tang

et al. 2018

Eur J Pediatr

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The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ≤ 4.0 days after the onset of symptoms were more likely to be IVIG resistant.Conclusion: The initial administration of IVIG ≤ 4.0 days after the onset of symptoms increased ESR and decreased hemoglobin and platelet counts, oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, and polymorphous rash and are the risk factors for IVIG-resistant Kawasaki disease. What is Known: • Recent reports on this topic are about aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase, total bilirubin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), polymorphonuclear leukocytes (PMN), C-reactive protein (CRP), pro-brain natriuretic peptide (BNP), albumin, and sodium as the risk factors in the IVIG-resistant Kawasaki disease; however, no studies have been published on clinical features as predictors of IVIG resistance. What is New: • This meta-analysis identified the clinical features, the initial administration of IVIG ≤ 4.0 days after the onset of symptoms, and much more comprehensive laboratory indicators, such as hemoglobin, as predictors of IVIG-resistant Kawasaki disease. Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3182-2) contains supplementary material, which is available to authorized users.

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“… 13) The predictors for the development of CAL in patients with KD have been reported to be male sex, fever duration, and increased serum CRP level and white blood cell (WBC) count as per some studies, whereas other studies reported higher NT-proBNP levels as a predictor. 14) 15) …”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Lesion in Patients with Kawasaki Disease: Analysis of the Korean Nationwide Multicenter Survey from 2012 to 2014

Kim

Song²,

Kim

2018

Korean Circ J

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Background and ObjectivesApproximately 10–15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD.MethodsWe retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals.ResultsAmong 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p<0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p<0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p<0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p<0.01), while PMN, NT-proBNP, AST, and ALT were not.ConclusionsElevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.

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Non-Responders to Intravenous Immunoglobulin and Coronary Artery Dilatation in Kawasaki Disease: Predictive Parameters in Korean Children

Cited by 31 publications

References 30 publications

Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease

Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease

Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a meta-analysis of 4442 cases

Factors Predicting Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Lesion in Patients with Kawasaki Disease: Analysis of the Korean Nationwide Multicenter Survey from 2012 to 2014

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