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Prediction of Intravenous Immunoglobulin Non-responders in Patients with Kawasaki Disease

Korean Journal of Pediatrics 2004;47(1):90-94.
Published online January 15, 2004.
Prediction of Intravenous Immunoglobulin Non-responders in Patients with Kawasaki Disease
Gi Bum Lee, Ji-Won Lee, Kyung-Yil Lee
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
가와사끼병에서 정맥용 면역글로불린 불응군의 예측
이기범, 이지원, 이경일
가톨릭대학교 의과대학 소아과학교실
Correspondence: 
Kyung-Yil Lee, Email: leekyungyil@catholic.ac.kr
Abstract
Purpose
: We evaluated the effects of intravenous immunoglobulin(IVIG) on the levels of laboratory indices examined serially according to the responsiveness to IVIG therapy in children with Kawasaki disease(KD).
Methods
: Children with KD(n=63) who had been treated with IVIG at a dosage of 2.0 g/kg were classified into two groups : the IVIG-resistant(consistent fever over 48 hours after initiation of IVIG infusion, n=9) and the IVIG-responsive(defervescence within 48 hours, n=54). The levels of various laboratory indices were determined three times during admission : before, 24 hours after and seven days after IVIG administration.
Results
: Among the nine children in the IVIG-resistant group, four(44.4% vs 9.3% in IVIG-responsive group, P=0.019) had coronary artery lesions(CAL). On comparing the two groups, the following statistically significant differences(P<0.05) in the levels of laboratory parameters were found in the IVIG-resistant group relative to the IVIG-responsive group : C-reactive protein(CRP) level was higher(19.0 mg/dL vs 10.9 mg/dL), but the platelet count, total protein, and total cholesterol levels were lower before IVIG infusion; the white blood cell(WBC) and neutrophil counts, and the CRP level were higher, but the platelet count was lower 24 hours after IVIG administration; WBC and neutrophil counts, and the CRP and erythrocyte sedimentation rate levels were higher, but hemoglobin and albumin levels were lower seven days after IVIG administration.
Conclusion
: Approximately 15% of patients with KD did not respond to single dose IVIG treatment (2.0 g/kg). IVIG-resistant patients have a higher risk of CAL and seem to be predicted from high CRP levels(>16 mg/dL) before IVIG treatment and persistently elevated levels of CRP(>11 mg/ dL), WBC(>12,000/mm3) and neutrophil counts(>6,500/mm3) 24 hours after IVIG administration.
Key Words: Kawasaki disease, Intravenous Immunoglobulin, C-reactive protein, White blood cell, Neutrophil, Coronary artery disease


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