Document Detail

Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease.
MedLine Citation:
PMID:  16887442     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The objective of this study was to find the predictors and generate a prediction score of resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD). STUDY DESIGN: Patients diagnosed as having KD were sampled when they received initial high-dose IVIG treatment (2 g/kg dose) within 9 days of illness (n = 320). These patients were divided into 2 groups: the resistance (n = 41) and the responder (n = 279). The following data were obtained and compared between resistance and responder: age, sex, illness days at initial treatment, and laboratory data. RESULTS: Multivariate logistic regression analysis identified age, illness days, platelet count, alanine aminotransferase (ALT), and C-reactive protein (CRP) as significant predictors for resistance to IVIG. We generated prediction score assigning 1 point for (1) infants less than 6 months old, (2) before 4 days of illness, (3) platelet count <or= 30 x 10(10)/L, (4) CRP >or= 8 mg/dL, as well as 2 points for (5) ALT >or= 80 IU/L. Using a cut-off point of 3 and more with this prediction score, we could identify the IVIG-resistant group with 78% sensitivity and 76% specificity. CONCLUSIONS: Resistance to IVIG treatment can be predicted using age, illness days, platelet count, ALT, and CRP. Randomized, multicenter clinical trials are necessary to create a new strategy to treat these high-risk patients.
Kimiyasu Egami; Hiromi Muta; Masahiro Ishii; Kenji Suda; Yoko Sugahara; Motofumi Iemura; Toyojiro Matsuishi
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  149     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-04     Completed Date:  2006-09-07     Revised Date:  2007-04-11    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  237-40     Citation Subset:  AIM; IM    
Department of Pediatrics, Kurume University, Kurume, Japan.
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MeSH Terms
Acute Disease
Alanine Transaminase / blood
Blood Platelets
Child, Preschool
Drug Administration Schedule
Drug Resistance*
Immunoglobulins, Intravenous / therapeutic use*
Mucocutaneous Lymph Node Syndrome / drug therapy*
Prospective Studies
Risk Factors
Sensitivity and Specificity
Reg. No./Substance:
0/Immunoglobulins, Intravenous; EC Transaminase
Comment In:
J Pediatr. 2007 Apr;150(4):e37; author reply e38   [PMID:  17382098 ]

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