Prediction of Intravenous Immunoglobulin Non-responders in Patients with Kawasaki Disease

Lee, Gi Bum; Lee, Ji Won; Lee, Kyung Yil

Abstract

PURPOSE
We evaluated the effects of intravenous immunoglobulin(IVIG) on the levels of laboratory indices examined serially according to the responsiveness to IVIG therapy in children with Kawasaki disease(KD).
METHODS
Children with KD(n=63) who had been treated with IVIG at a dosage of 2.0 g/kg were classified into two groups: the IVIG-resistant(consistent fever over 48 hours after initiation of IVIG infusion, n=9) and the IVIG-responsive(defervescence within 48 hours, n=54). The levels of various laboratory indices were determined three times during admission: before, 24 hours after and seven days after IVIG administration.
RESULTS
Among the nine children in the IVIG-resistant group, four(44.4% vs 9.3% in IVIG-responsive group, P=0.019) had coronary artery lesions(CAL). On comparing the two groups, the following statistically significant differences(P<0.05) in the levels of laboratory parameters were found in the IVIG-resistant group relative to the IVIG-responsive group:C-reactive protein(CRP) level was higher(19.0 mg/dL vs 10.9 mg/dL), but the platelet count, total protein, and total cholesterol levels were lower before IVIG infusion; the white blood cell(WBC) and neutrophil counts, and the CRP level were higher, but the platelet count was lower 24 hours after IVIG administration; WBC and neutrophil counts, and the CRP and erythrocyte sedimentation rate levels were higher, but hemoglobin and albumin levels were lower seven days after IVIG administration.
CONCLUSION
Approximately 15% of patients with KD did not respond to single dose IVIG treatment (2.0 g/kg). IVIG-resistant patients have a higher risk of CAL and seem to be predicted from high CRP levels(>16 mg/dL) before IVIG treatment and persistently elevated levels of CRP(>11 mg/ dL), WBC(>12,000/mm3) and neutrophil counts(>6,500/mm3) 24 hours after IVIG administration.