Predicting Factors for Refractory Kawasaki Disease

Do, Youngkyu; Kim, Ki-Won; Chun, Jongsuk; Ho, Byung; Namgoong, Mee Kyung; Lee, Hae Yong

doi:10.4070/kcj.2010.40.5.239

Cited by 33 publications

(30 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found no difference in the incidence of rKD with regard to gender, age, or ethnicity. Some of these fi ndings are in accordance with results of studies by Do et al, 14 Cha et al, 15 and Durongpisitkul et al, 16 who have reported similar age and gender distribution between rKD and sKD in Korea and Thailand. Our results contrast with other studies that have found younger age to be a predictor for rKD.…”

Section: Discussionsupporting

confidence: 82%

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Ghelani

Pastor²,

Parikh³

2012

Hospital Pediatrics

View full text Add to dashboard Cite

Objective: Approximately 10% to 15% of Kawasaki disease (KD) is refractory to treatment with initial intravenous immunoglobulin (IVIG). However, there is no consensus on pharmacologic treatment of refractory KD (rKD). Demographic characteristics of patients with rKD and regional variability in their treatment in the United States have not been reported on a large scale. The goal of this study was to describe the demographic and treatment variability in rKD by using a large multi-institutional database. Methods: Data were obtained for patients with KD from January 2005 to June 2009 by using the Pediatric Health Information System. Patients who received a single dose of IVIG were labeled as having standard KD (sKD) and those who required additional medications were labeled as having rKD. Results: Of the 5633 patients studied, 4818 (85.5%) received 1 dose of IVIG (sKD) and 815 (14.5%) received >1 medication (rKD). Median age was 30 months (interquartile range: 14-53) and 30 months (interquartile range: 15-54) for rKD and sKD patients, respectively (P= .438). No significant change was noted in the gender or ethnic distribution of patients between rKD and sKD groups. Seasonal distribution of rKD was comparable to sKD. IVIG was the most common (64.5%) initial medication chosen to treat rKD, followed by methylprednisolone (27.1%) and infliximab (8.3%); however, there was significant regional variability. Of patients with rKD, 81% required only 1 additional medication (after the initial IVIG) for treatment. Conclusions: Patients with rKD have similar age, gender, ethnic, and seasonal distribution as sKD patients. IVIG is the most common initial medication chosen to treat rKD; however, there is regional variation.

show abstract

Section: Discussionsupporting

confidence: 82%

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Ghelani

Pastor²,

Parikh³

2012

Hospital Pediatrics

View full text Add to dashboard Cite

show abstract

“…Tremoulet et al10) mentioned high percent band count, long illness day, high gamma-glutamyl transferase, and low age-adjusted Hb as the risk predictors of IVIG-nonresponders. In Korea as well, Do et al11) reported that low albumin, low sodium, and high neutrophil proportion were significant in the IVIG-resistant group. Changes in these biomarkers are the effects of diverse cytokines (interleukin [IL]-1β, TNF-α, interferon (IFN)-γ, IFN-α, IL-4, IL-6, IL-8, IL-10, transforming growth factor-β, matrix metalloproteinase, vascular endothelial growth factor (VEGF) increasing at the early stage2,5).…”

Section: Discussionmentioning

confidence: 99%

Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease

et al. 2013

View full text Add to dashboard Cite

PurposeIt has been reported that 10% to 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment. In this study, we aimed to identify useful predictors of therapeutic failure in children with KD.MethodsWe examined 309 children diagnosed with KD at the Kyungpook National University Hospital and the Inje University Busan Paik Hospital between January 2005 and June 2011. We retrospectively reviewed their medical records and analyzed multiple parameters in responders and nonresponders to IVIG.ResultsAmong the 309 children, 30 (9.7%) did not respond to IVIG. They had significantly higher proportion of neutrophils, and higher levels of aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, and N-terminal fragment of B-type natriuretic peptide than did responders. IVIG-nonresponders had a significantly longer duration of hospitalization, and more frequently experienced coronary artery lesion, and sterile pyuria. No differences in the duration of fever at initial treatment or, clinical features were noted.ConclusionTwo independent predictors (ALT≥84 IU/L, total bilirubin≥0.9 mg/dL) for nonresponse were confirmed through multivariate logistic regression analysis. Thus elevated ALT and total bilirubin levels might be useful in predicting nonresponse to IVIG therapy in children with KD.

show abstract

“…They indentified seven variables to generate a scoring model useful to predict IVIG resistance: days of illness at initial treatment ≤ 4, age ≤ 12 months at the onset, high serum levels of AST ≥100 IU/L, high CRP (≥10 mg/dl), elevated percentage of neutrophils (≥80 %), low serum sodium levels (≤133 mmol/L), low platelet count (≤30.0 × 10 4 /mm 3 ) [10]. Other authors included a lower lymphocytes count in the Kobayashi score to increase the predictive value of IVIG-resistant patients during the subacute phase [11]. However the score has not performed well in non-Japanese populations [12].…”

Section: Introductionmentioning

confidence: 99%

Kawasaki disease in Sicily: clinical description and markers of disease severity

et al. 2016

View full text Add to dashboard Cite

BackgroundKawasaki disease (KD) is an acute systemic vasculitis of small and middle size arteries; 15-25 % of untreated patients and 5 % of patients treated with intravenous immunoglobulin (IVIG) develop coronary artery lesions (CAL). Many studies tried to find the most effective treatment in the management of resistant KD and to select the risk factors for CAL.Our data are assessed on children from west Sicily, characterized by a genetic heterogeneity.MethodsWe studied the clinical data of 70 KD Sicilian children (36 males: 51 %; 34 females: 49 %), analysed retrospectively, including: demographic and laboratory parameters; echocardiographic findings at diagnosis, at 2, 6 and 8 weeks, and at 1 year after the onset of the illness.ResultsForty-seven had Typical KD, three Atypical KD and twenty Incomplete KD. Age at the disease onset ranged from 0.1 to 8.9 years. IVIG were administered 5 ± 2 days after the fever started. Defervescence occurred 39 ± 26 hours after the first IVIG infusion. Fifty-six patients (80 %) received 1 dose of IVIG (responders); 14 patients (20 %) had a resistant KD, with persistent fever after the first IVIG dose (non responders). Ten (14 %) non responders responded to the second dose, 4 (5 %) responded to three doses; one needed treatment with high doses of steroids and Infliximab.Cardiac involvement was documented in twenty-two cases (eighteen with transient dilatation/ectasia, fifteen with aneurysms). Pericardial effusion, documented in eleven, was associated with coronaritis and aneurysms, and was present earlier than coronary involvement in seven.Hypoalbuminemia, D-dimer pre-IVIG, gamma-GT pre-IVIG showed a statistically significant direct correlation with IVIG doses, highlighting the role of these parameters as predictor markers of refractory disease. The persistence of elevated CRP, AST, ALT levels, a persistent hyponatremia and hypoalbuminemia after IVIG therapy, also had a statistical significant correlation with IVIG doses.Non responders showed higher levels of D-dimer and gamma-GT pre-IVIG, persistent high levels of D-dimer, CRP, AST, ALT, hypoalbuminemia and hyponatremia after IVIG.ConclusionsThis is the first study on KD in Sicily. We suggest some laboratory parameters as predictive criteria for resistant KD. Patients who show early pericarditis need careful surveillance for coronary lesions.

show abstract

Predicting Factors for Refractory Kawasaki Disease

Cited by 33 publications

References 28 publications

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease

Kawasaki disease in Sicily: clinical description and markers of disease severity

Contact Info

Product

Resources

About