The time option of IVIG treatment is associated with therapeutic responsiveness and coronary artery abnormalities but not with clinical classification in the acute episode of Kawasaki disease

Abstract

Background In the last decade, incomplete Kawasaki disease (KD), intravenous immunoglobulin (IVIG) non-response and coronary artery abnormalities (CAA) have experienced the increasing trends in China. In addition, the enhancement of pediatricians’ awareness may also raise the diagnostic rate of incomplete KD and stimulate more aggressive initial therapy in the acute episode of KD. Given this background, we hypothesize that the time option of IVIG treatment should be in parallel with peak time of systemic inflammation; either earlier or later IVIG treatment may affect the clinical classification, therapeutic responsiveness and CAA occurrence in KD patients. Therefore, the major objective of the present study is to identify whether the time option of IVIG treatment could be associated with the clinical classification, therapeutic responsiveness and CAA occurrence in the acute episode of KD. Materials and methods A total of 153 children with KD were recruited between July 2015 and May 2018. All patients received the standard therapy of KD, including a single infusion of IVIG (2 g/kg) and aspirin (30–50 mg/kg/d). Blood samples were collected from all subjects within 24 h pre-IVIG treatment, respectively. Echocardiography was performed during the period from 2 days to 14 days after IVIG treatment. Results (1) The clinical classification presented no significant heterogenicity among different treatment time ( x 2 = 1.59, p > 0.05) (2) Eleven KD patients resisted to IVIG treatment and 7 of them (63.60%) received the initial IVIG dose on day 5 and 6. (3) The distribution of CAA onset was subjected to a significant difference according to timing option of IVIG treatment ( x 2 = 11.94, p < 0.05). Conclusions The time option of IVIG treatment is associated with therapeutic responsiveness and CAA but not with clinical classification in the acute episode of KD.

Retrospective analysis of clinical characteristics and related influencing factors of Kawasaki disease

“…Children with KD often show elevated WBC, PLT, accelerated ESR, elevated CRP level, abnormal liver function, and abnormal urine test. [ 1 , 18 ] Although they cannot be used as diagnostic indicators alone, their changes are helpful for the early diagnosis of IKD. The results of this study showed that the laboratory indexes of KD children, such as CRP, WBC, ESR, ALB, HCT, PLT, ALT, AST, NT-proBNP, Hb, NEUT, had some changed when compared with the normal range.…”

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

“…It was suggested that the timing of IVIG treatment influenced the reactivity to treatment regardless of the severity of KD. Besides, It was reported that in patients with KD, inflammatory mediators, including plasma white blood cell count, absolute neutrophil count, and CRP peak within 5–10 days of KD onset, thus, the inappropriate timing of IVIG treatment may lead to an increased incidence of IVIG unresponsiveness ( 47 ). However, owing to the potential confounders between groups, subsequent studies are still needed to focus on controlling for differences in patients' baseline characteristics in order to obtain reliable results.…”

Very early onset of coronary artery aneurysm in a 3-month infant with Kawasaki disease: a case report and literature review

“…We treated our patient with a second dose of IVIG along with steroids (2 mg/kg) with a full clinical response. Recent studies have also found that the incidence of coronary artery lesions (CAL) varies significantly depending on the timing of IVIG treatment, suggesting that early use of IVIG is an effective method to inhibit systemic inflammation and prevent CAL [ 18 ].…”