Analysis of Potential Risk Factors Associated With... : The Pediatric Infectious Disease Journal (original) (raw)

Original Studies

Analysis of Potential Risk Factors Associated With Nonresponse to Initial Intravenous Immunoglobulin Treatment Among Kawasaki Disease Patients in Japan

Uehara, Ritei MD*†; Belay, Ermias D. MD*; Maddox, Ryan A. MPH*; Holman, Robert C. MS*; Nakamura, Yosikazu MD, MPH†; Yashiro, Mayumi†; Oki, Izumi MD†; Ogino, Hirotaro MD‡; Schonberger, Lawrence B. MD*; Yanagawa, Hiroshi MD†

From the *The Division of Viral and Rickettsial Diseases, National Center for Zoonotic Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan; and ‡Department of Pediatrics, Kansai Medical University, Moriguchi, Osaka, Japan.

Accepted for publication August 22, 2007.

This research was supported in part by grants from the Ministry of Health, Labor, and Welfare in Japan. This research was also supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention, Division of Viral and Rickettsial Diseases, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC.

Address for correspondence: Ritei Uehara, MD, The Division of Viral and Rickettsial Diseases, National Center for Zoonotic Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS-A39, Atlanta, GA 30333. E-mail: [email protected].

Abstract

Background:

Some Kawasaki disease (KD) patients do not respond to initial treatment with intravenous immunoglobulin (IVIG). The purpose of this study was to determine potential risk factors associated with IVIG nonresponse among KD patients in Japan.

Methods:

Data were obtained from questionnaires used for the 18th nationwide KD survey of patients who visited hospitals in Japan from 2003 through 2004. Data for patients who met the case definition for KD and received 2 g/kg single infusion IVIG as the initial treatment within 10 days of illness were analyzed. IVIG nonresponders were defined as patients who needed secondary treatment after initial IVIG administration.

Results:

Among 15,940 KD patients in Japan during 2003–2004, 6330 patients received 2 g/kg single infusion IVIG within 10 days of illness onset. IVIG nonresponders accounted for 20.3% of them (n = 1286). Male sex [odds ratio (OR), 1.21, 95% confidence interval (CI), 1.06–1.37], receipt of the initial IVIG before the fifth day of illness (OR: 1.89, 95% CI: 1.66–2.15), and having recurrent KD (OR: 1.38, 95% CI: 1.00–1.90) were significantly associated with IVIG nonresponse. In addition, IVIG nonresponders had significantly higher risks for coronary artery aneurysms (OR: 10.38, 95% CI: 6.98–15.45) or giant coronary artery aneurysms (OR: 54.06, 95% CI: 12.84–227.65).

Conclusions:

Physicians should consider potential IVIG nonresponse among recurrent KD patients or KD patients diagnosed and treated before the fifth day of illness, particularly if they are boys and have laboratory values associated with nonresponse such as low platelet count, and elevated alanine aminotransferase and C-reactive protein. Some of these patients may benefit from administration of the alternative secondary treatment early during the illness along with the initial IVIG treatment.