Early Appearance of Principal Symptoms of Kawasaki Disease is a Risk Factor for Intravenous Immunoglobulin Resistance

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• 作者：Miyu Tajima ; Yusuke Shiozawa ; Jiro Kagawa
• 关键词：Kawasaki disease ; IVIG ; Coronary artery aneurysm ; Non ; responder ; Principal symptom ; Risk score
• 刊名：Pediatric Cardiology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：36
• 期：6
• 页码：1159-1165
• 全文大小：691 KB
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• 作者单位：Miyu Tajima (1) (2)
  Yusuke Shiozawa (2) (3)
  Jiro Kagawa (2)
  
  1. Department of Cardiology, University of Tokyo, Tokyo, Japan
  2. Department of Pediatrics, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-677, Japan
  3. Department of Pediatrics, University of Tokyo, Tokyo, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

It is difficult to accurately predict treatment resistance in Kawasaki disease (KD). Patients considered to be low-risk cases often develop resistance to intravenous immunoglobulin (IVIG). We herein examined whether information from the clinical course of KD could improve the prediction accuracy of a previously reported risk score. We retrospectively reviewed the clinical records of 100 KD patients. The clinical characteristics and laboratory data were compared between IVIG-sensitive and IVIG-resistant patients and also between patients with and without coronary artery aneurysm (CAA). The total incidence of IVIG resistance and CAA development was 34 and 13?%, respectively. Multiple regression analysis identified the early appearance of principal symptoms (≤day 2 of the illness) as a risk factor for IVIG resistance (OR 2.88, 95?% CI 1.11-.44, p?=?0.0041), whereas delayed IVIG administration (≥day 6) (OR 2.23, 95?% CI 0.66-.64, p?=?0.018) and IVIG resistance (OR 9.05, 95?% CI 2.27-6.10, p?=?0.015) were independent predictors for CAA development. The addition of the first appearance day of principal symptoms into a previously reported scoring system improved its prediction accuracy for IVIG resistance. KD patients who had presented with any principal symptoms within 2?days of fever onset were at a high risk for IVIG resistance regardless of previously reported risk score. A careful medical history-taking that is focused on the clinical course enables a better prediction of IVIG resistance.