What is it about?
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 Creactive 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.
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Why is it important?
This study identified the usefulness of the CRP ratio as a parameter for guiding rescue therapy for initial IVIG resistance. The establishment of this parameter is important for the suppression of CAL development caused by Kawasaki disease.
Perspectives
This study showed the favorable outcome of initial IVIG therapy with DUA in preventing large CAL. In addition to effective rescue therapies, including plasma exchange, removal of the negative impact of anti-inflammatory drugs during initial IVIG therapy by DUA may be another method for suppressing CAL. A recent study revealed that the concomitant use of medium- or higher-dose aspirin with IVIG therapy was inferior to the use of low-dose aspirin, which does not have the same effect as antiinflammatory drugs, for the suppression of CAL in acute Kawasaki disease. Another, more recent study also suggested the usefulness of the delayed use of low-dose aspirin for preventing large CAL. These findings are consistent with the beneficial effect of removing the negative impact of anti-inflammatory drugs on initial IVIG therapy, and with the favorable outcome of CAL in the present study.
Toshimasa Nakada
Aomori Prefectural Central Hospital
Read the Original
This page is a summary of: Parameters to Guide Rescue Therapy for Intravenous Immunoglobulin-resistant Kawasaki Disease, Journal of Advances in Medicine and Medical Research, January 2017, Sciencedomain International,
DOI: 10.9734/jammr/2017/35081.
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