Background: Recently, several studies to predict the unresponsiveness to initial intravenous immunoglobulin (IVIG) treatment during the acute phase of Kawasaki disease have been conducted. However, reported predictors are varied in those studies. The racial difference was assumed as the cause of such diversity. The aim of this study is to find predictors of unresponsiveness to initial IVIG in Korean children with Kawasaki disease.
Subjects and methods: Subjects were 424 patients with Kawasaki disease who had been admitted to Asan Medical Center from January 2006 to December 2012. Demographic, clinical, and laboratory data were investigated through a review of medical records. Laboratory data before initial IVIG treatment and within 10 days after fever onset were selected. Forty one patients (9.7%) were non responders to initial IVIG treatment. Univariate and multivariate logistic regression analyses were performed to find predictors of unresponsiveness to initial IVIG treatment.
Results: Median age was 30.0 months (range 1.6-186.0 months) in IVIG-responders, and 30.9 months (range 2.9-107.8 months) in IVIG-nonresponders (P=0.819). Number of females was 156 (40.7%) and 15 (36.6%) respectively (P=0.607). No other demographic and clinical variables were different between two groups. Univariate analyses showed that neutrophil percentage (P<0.001), serum C-reactive protein (P=0.008) and total bilirubin (P<0.001) were higher, and that serum protein level (P=0.001), albumin level (P<0.001), sodium concentration (P<0.001), and chloride concentration (P=0.002) were lower in IVIG-nonresponders. Neutrophil percentage (OR 1.075, 95% confidence interval 1.027~1.125. P=0.002) and serum total bilirubin(OR 1.845, 95% interval 1.284~2.650. P=0.001) were significant predictors in Multivariate analyses.
Conclusion: The results of this study were inconsistent with the results of previously conducted studies with the same purpose in other countries. Therefore future study with more number of subjects is needed for confirmative identification of predictors of unresponsiveness to initial IVIG treatment in patients with Kawasaki disease.