Background and Objectives: Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment, and if untreated approximately 15% to 25% of patients with KD have complications. The aim of our study is to find more useful predictors of responsiveness to initial IVIG in KD.
Subjects and Methods: We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Laboratory data obtained before and 24 to 36 hours after IVIG treatment were collected, which include hemoglobin level, white blood cell count, proportions of neutrophils, lymphocytes and eosinophils, platelet count, erythrocyte sedimentation rate, C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB) and N[[Unsupported Character - Codename ]]terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided in to 2 groups, IVIG-responsive and IVIG-resistant.
Results: Among the 91 patients, 11 patients (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophils, erythrocyte sedimentation rate, CRP, sodium, CK, CK-MB and NT[[Unsupported Character - Codename ]]proBNP were significantly different. In the after-IVIG laboratory parameters, hemoglobin level, white blood cell count, % neutrophils, % lymphocytes, CRP, CK, CK-MB and NT-proBNP were significantly different. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophils showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance.
Conclusion: FC-CRP might be a more useful and important value for predicting initial IVIG responsiveness in KD patients than before- and after-IVIG CRP.