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ORIGINAL ARTICLE
Korean J Pediatr 2013 February;56(2) :75-79.
Published online 2012 October 24.        doi:https://doi.org/10.3345/kjp.2013.56.2.75
Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease
Hyo Min Park (Park HM)1, Dong Won Lee (Lee DW)2, Myung Chul Hyun (Hyun MC)1, Sang Bum Lee (Lee SB)1
1Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
2Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
Corresponding Author: Dong Won Lee ,Tel: +82.53-940-7520, Fax: +82.53-940-7524, Email: rabitover@hanmail.net
Copyright © 2013 by The Korean Pediatric Society
ABSTRACT
Purpose: It has been reported that 10% to 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment. In this study, we aimed to identify useful predictors of therapeutic failure in children with KD.
Methods: We examined 309 children diagnosed with KD at the Kyungpook National University Hospital and the Inje University Busan Paik Hospital between January 2005 and June 2011. We retrospectively reviewed their medical records and analyzed multiple parameters in responders and nonresponders to IVIG.
Results: Among the 309 children, 30 (9.7%) did not respond to IVIG. They had significantly higher proportion of neutrophils, and higher levels of aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, and N-terminal fragment of B-type natriuretic peptide than did responders. IVIGnonresponders had a significantly longer duration of hospitalization, and more frequently experienced coronary artery lesion, and sterile pyuria. No differences in the duration of fever at initial treatment or, clinical features were noted.
Conclusion: Two independent predictors (ALT84 IU/L, total bilirubin0.9 mg/dL) for nonresponse were confirmed through multivariate logistic regression analysis. Thus elevated ALT and total bilirubin levels might be useful in predicting nonresponse to IVIG therapy in children with KD.
Keywords: Kawasaki disease | Intravenous immunoglobulin | Predictor | Alanine aminotransferase | Total bilirubin
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