Predictors of Intravenous Immunoglobulin (IVIG) Resistance in Children with Kawasaki Disease in Calabria Region, Italy

Authors

1 Unit of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

2 Department of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

3 Unit of Pediatric Oncohematology, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

Abstract

Background
Kawasaki disease (KD) is the second most common childhood vasculitis and one of the main causes of acquired heart disease in children. Recent work focuses on the early diagnostic importance of those risk factors that indicate resistance to intravenous immunoglobulin (IVIG) treatment. The objectives of this study were to identify clinical, laboratory and/or instrumental factors that could be correlated with the risk of resistance to IVIG and the applicability of standard score systems.
Materials and Methods
We retrospectively reviewed clinical records of 23 children with KD, diagnosed in five consecutive years. They all underwent laboratory and echocardiography investigations and initial treatment with IVIG. Based on the response to IVIG they were divided into two groups: IVIG responders (n=14), and IVIG non-responders (n=9).
Results
39% (n= 9) of patients were non-responders. Laboratory exams were overlapping between the two groups except for platelets (p <0.05), and for triglycerides (p<0.01). Among the patients who showed cardiac involvement, 67% were IVIG-resistant (p=0.0094; odds ratio [OR] = 20.0). Coronary artery abnormalities (CAA) at onset were present in 8.69% of patients, all non-responders (p=0.1423; OR=9.66). In this group of patients there were lower values ​​of sodium (p<0.05), and of albumin (p<0.04), and higher bilirubin (p<0.01).
Conclusion
In our population it has emerged that some laboratory (low platelet levels, high triglyceride levels), and instrumental factors (CAA at onset, especially if associated with hyponatremia, hypoalbuminemia and hyperbilirubinemia) should be evaluated at the time of diagnosis, as important prognostic factors with a more severe KD shape and greater resistance to IVIG.

Keywords