Document Detail


Prediction of responsiveness or non-responsiveness to treatment of acute Kawasaki disease using 1 gram per kilogram of immunoglobulin--an effective and cost-saving schedule of therapy.
MedLine Citation:
PMID:  19272202     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Standard treatment of acute Kawasaki disease involves giving 2 grams per kilogram of immunoglobulin intravenously along with aspirin. More than half of the patients with acute Kawasaki disease, nonetheless, can be cured by giving only 1 gram per kilogram of immunoglobulin, thus reducing this aspect of the cost of treatment by half. Our purpose was to predict those patients with acute Kawasaki disease who would respond to treatment with 1 gram per kilogram of immunoglobulin given intravenously on the basis of their clinical profiles and laboratory findings prior to the initial treatment. We performed a retrospective review of the clinical records of consecutive patients with acute Kawasaki disease treated in our hospital with intravenous immunoglobulin from January, 2001, to December, 2005.During this period, we treated in this fashion 98 patients with acute Kawasaki disease. 65% of these needing immunoglobulin therapy were cured by giving 1 gram per kilogram. The neutrophil count and the percentage of white blood cells representing neutrophils, along with aspirate aminotransferase, alanine aminotransferase, bilirubin and C reactive protein, were all significantly lower, and sodium was significantly higher, in those responding to 1 gram per kilogram of immunoglobulin when compared to those who did not respond. The days of illness at the first intravenous treatment was later in those responding than in those failing to respond. We generated a score for prediction, assigning a point for each of C reactive protein equal to or greater than 10 mg/dl, sodium equal to or lower than 133 meq/l, alanine aminotransferase equal to or greater than 110 IU/l, and 2 points for the percentage of white blood cells representing neutrophils equal to or greater than 70%. Using a cut-off point of a score less than 2, we were able to identify those responding with 60% sensitivity, and 91% specificity.Thus, we are now able to predict those patients with acute Kawasaki disease who will respond to immunoglobulin given intravenously at 1 gram per kilogram using laboratory data, with a potential saving in medical costs.
Authors:
Ko Ichihashi; Hirohiko Shiraishi; Mariko Momoi
Publication Detail:
Type:  Journal Article     Date:  2009-03-10
Journal Detail:
Title:  Cardiology in the young     Volume:  19     ISSN:  1467-1107     ISO Abbreviation:  Cardiol Young     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-11     Completed Date:  2009-10-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  224-7     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Saitama Medical Center of Jichi Medical University, Saitama, Japan. koichihashi@jichi.ac.jp
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MeSH Terms
Descriptor/Qualifier:
C-Reactive Protein / analysis
Child
Child, Preschool
Coronary Vessels / ultrasonography
Humans
Immunoglobulins, Intravenous / administration & dosage*,  economics
Infant
Japan
Male
Mucocutaneous Lymph Node Syndrome / blood,  drug therapy*,  economics,  ultrasonography
Neutrophils
Prognosis
Sodium / blood
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunoglobulins, Intravenous; 7440-23-5/Sodium; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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