Prediction of Repeated Intravenous Immunoglobulin Resistance in Children with Kawasaki Disease

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2021 Sep 17

PMID 34530763

Citations 7

Authors

Yaheng Lu

Tingting Chen

Yizhou Wen

Feifei Si

Xindan Wu

Yanfeng Yang

Affiliations

Soon will be listed here.

Abstract

Background: Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD.

Methods: A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis.

Results: The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD.

Conclusions: Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.

Citing Articles

Nutrition-Associated Biomarkers in Predicting Intravenous Immunoglobulin Resistance and Coronary Artery Lesions in Kawasaki Disease: A Systematic Review and Meta-Analysis.

Liu L, Chen R, Wang H, Yu H, Ai Z, Zhang X Food Sci Nutr. 2025; 13(1):e4647.

PMID: 39803242 PMC: 11717057. DOI: 10.1002/fsn3.4647.

Role of Pyroptosis in IVIG-Resistant Kawasaki Disease and the Establishment of a New Predictive Model.

Li S, Zhou Y, Wen Y, Wu Y, Liu F, Ding Y J Inflamm Res. 2024; 17:10999-11008.

PMID: 39691305 PMC: 11651135. DOI: 10.2147/JIR.S490095.

Effectiveness of Initial Corticosteroid Treatment in Kawasaki Disease Children Suspected to be IVIG Resistant.

Wang X, Shi X, Guo X, Chen S, Lin X, Yang F Pediatr Cardiol. 2024; .

PMID: 39316082 DOI: 10.1007/s00246-024-03657-9.

Combination of S100A12/TLR2 signaling molecules and clinical indicators in a new predictive model for IVIG-resistant Kawasaki disease.

Wu Y, Liu P, Zhou Y, Yang Y, Li S, Yin W Sci Rep. 2024; 14(1):7261.

PMID: 38538656 PMC: 10973373. DOI: 10.1038/s41598-024-57897-z.

Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study.

Shuai S, Zhang H, Zhang R, Tang M, Luo E, Yang Y J Pediatr (Rio J). 2023; 99(4):406-412.

PMID: 36977496 PMC: 10373155. DOI: 10.1016/j.jped.2023.02.005.

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