Parameters to Guide Rescue Therapy for Intravenous Immunoglobulin-resistant Kawasaki Disease

Abstract

Aims: To identify the most useful parameter to guide rescue therapy among the IVIG-resistant patients who received an initial single IVIG therapy dose with a delayed use of anti-inflammatory drugs (DUA) for Kawasaki disease. Methods: The parameters of 174 patients who received the initial IVIG therapy at 2 g/kg/dose with DUA were investigated. These patients were divided into 135 IVIG-responders (responder group) and 39 IVIG-resistant patients. The 39 IVIG-resistant patients were further divided into two groups, a rescue group with 15 patients who received rescue therapies for initial IVIG therapy resistance and a non-rescue group with 24 children who did not receive the rescue therapy for resistance. Four parameters, including neutrophil counts, neutrophil %, neutrophil to lymphocyte ratio and C-reactive protein (CRP) value after initial IVIG therapy, were investigated retrospectively, as was the ratio of each parameter, defined as the ratio of the values after/before initial IVIG therapy. Results: All four parameters and their ratios were significantly different among 3 groups (P < .05). Among these parameters, the ratio of CRP for the rescue group had the highest sensitivity and specificity, at 90.8%. Furthermore, the logistic regression analysis showed that only the ratio of CRP was an independent predictor for rescue group (P < .001, odds ratio: 66.807, 95% confidence interval: 7.468 ～ 597.655). Conclusion: The ratio of CRP may be the most useful parameter for guiding rescue therapy among the IVIG-resistant patients who received an initial single IVIG therapy dose with DUA for Kawasaki disease.