Prediction of Intravenous Immunoglobulin Unresponsiveness in Patients With Kawasaki Disease

Kobayashi, Toshimitsu; Inoue, Yoshinari; Takeuchi, Kazuo; Okada, Yasunori; Tamura, Kazushi; Tomomasa, Takeshi; Kobayashi, T.; Morikawa, Akihiro

doi:10.1161/circulationaha.105.592865

Cited by 735 publications

(805 citation statements)

References 33 publications

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“…Multiple scoring systems for predicting IVIG-resistance in patients with KD have been published from other countries (2,(12)(13)(14). However, the only scoring system for which we had all of the variables in our database was published by Egami et al from Japan (12).…”

Section: Resultsmentioning

confidence: 99%

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Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

Tremoulet

Best

Song

et al. 2008

The Journal of Pediatrics

360

295

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Objectives-To explore the increased incidence of intravenous immunoglobulin (IVIG) resistance among San Diego County Kawasaki disease (KD) patients in 2006 and to evaluate a scoring system to predict IVIG-resistant patients with KD.Study design-We performed a retrospective review of patients with KD treated within 10 days of fever onset. Using multivariate analysis, independent predictors of IVIG-resistance were combined into a scoring system. 2006, 38.3 % of patients with KD in San Diego County were IVIG-resistant, a significant increase over previous years. IVIG-resistance was not associated with a particular brand or lot of IVIG. Resistant patients were diagnosed earlier, had higher % bands, and higher concentrations of C-reactive protein, alanine aminotransferase, and γ-glutamyl transferase (GGT). They also had lower platelet counts and age-adjusted hemoglobin (zHgb) concentrations and were more likely to have aneurysms (p=0.0008). A scoring system developed to predict IVIG-resistant patients using illness day, % bands, GGT, and zHgb, had a sensitivity of 73.3% and specificity of 61.9%. Results-InConclusions-An unexplained increase in IVIG-resistance was noted among patients with KD in San Diego County in 2006. Scoring systems based on demographic and laboratory data were insufficiently accurate to be clinically useful in our ethnically diverse population. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Keywords Conflict of Interests:The authors have no conflicts of interest to report. Kawasaki disease (KD), the leading cause of pediatric acquired heart disease in the United States and Japan, is an acute, systemic vasculitis. Treatment with a single dose of intravenous immunoglobulin (IVIG) and high-dose aspirin results in resolution of fever in most patients and significantly reduces the rate of coronary artery aneurysms (1). Despite this success, 10-20% of children will have persistent or recrudescent fever after their first infusion of IVIG (2-5). These patients are at increased risk of developing coronary artery abnormalities (5,6). Additional therapies used in these patients include retreatment with IVIG, immunomodulatory agents such as infliximab, high dose methylprednisolone, cyclophosphamide, and plasmapheresis. (7-11). Identification of patients who are likely to be IVIG-resistant would allow the use of additional therapies early in the course of their illness when prevention of coronary artery damage might still be possible. NIH Public AccessA number of recent studies from Asia have identified demographic and laboratory characteristics, including age...

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Section: Resultsmentioning

confidence: 99%

“…A number of recent studies from Asia have identified demographic and laboratory characteristics, including age, illness day, platelet count, erythrocyte sedimentation rate (ESR), and concentrations of hemoglobin, C-reactive protein (CRP), lactate dehydrogenase, and alanine aminotransferase (ALT) as predictors of IVIG-resistance (2,(12)(13)(14).…”

mentioning

confidence: 99%

Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

Tremoulet

Best

Song

et al. 2008

The Journal of Pediatrics

360

295

View full text Add to dashboard Cite

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“…Furthermore, the percentage of toxic neutrophils in the acute phase of KD tends to be higher in patients with CAL than in those without CAL [12]. Kobayashi et al reported a risk-scoring system for predicting IVIG resistance, in which the percentage of neutrophils (≥ 80%) is included as a factor [14]. Recently, we reported that an increased neutrophilto-lymphocyte ratio can independently predict IVIG resistance in KD patients [15,16].…”

Section: The Increased Number Of Neutrophils and The Morphological Chmentioning

confidence: 85%

The Role of Neutrophil Activation in the Pathogenesis of Kawasaki Disease

Takeshita¹,

Kawamura²,

Kanai³

et al. 2018

Pediatric Infect Dis

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In the acute phase of Kawasaki disease (KD), there is an increase in the number of circulating neutrophils, including toxic neutrophils, which are caused by a morphological change. The functions of the neutrophils are also activated, leading to the excessive production of reactive oxygen species and elastase, which may induce endothelial cell (EC) injury. Histological findings demonstrate that numerous neutrophils infiltrate into coronary artery lesions (CALs) during the early phase of KD. Thus, it is suggested that neutrophil-mediated EC injury may be involved in the formation of CALs in KD patients. In this review, we focus on the role of neutrophil activation in the pathogenesis of KD vasculitis and discuss the methods of treatment for neutrophil-mediated EC injury.

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“…Our results contrast with other studies that have found younger age to be a predictor for rKD. [17][18][19] We found higher prevalence of rKD in the southern region compared with the rest of the country; however, reasons for this variability are not known. Although failure to respond usually is defi ned as persistent or recrudescent fever >36 hours after completion of the initial IVIG infusion, there is no universal agreement on this definition.…”

Section: Discussionmentioning

confidence: 63%

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

Ghelani

Pastor²,

Parikh³

2012

Hospital Pediatrics

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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.

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Prediction of Intravenous Immunoglobulin Unresponsiveness in Patients With Kawasaki Disease

Cited by 735 publications

References 33 publications

Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

The Role of Neutrophil Activation in the Pathogenesis of Kawasaki Disease

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

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