Related Factors for Sensitivity to The Initial Dose of Intravenous Immunoglobulin in Children with Kawasaki Disease

Kawasaki disease (KD) involves systemic medium- and small-vessel vasculitides, manifested as acute fever and rash.

To investigate the factors for sensitivity to the initial dose of intravenous immunoglobulin (IVIG) in children with KD.

Clinical data of 222 KD children were retrospectively analyzed. Based on the response to the initial IVIG dose, they were divided into sensitivity and non-response groups. Clinical manifestations, laboratory results, and echocardiographic characteristics were compared between the study groups, and indicators with a significant difference were explored by logistic regression analysis. Receiver operating characteristic (ROC) curves were plotted using independent factors to determine the indicators for non-response.

Of 222 children, 181 (81.53%) were in the sensitivity group and 41 (18.47%) in the non-response group. The incidence rates of ultra-hyperpyrexia and coronary artery disease in the non-response group were significantly higher than that of the sensitivity group (P < 0.05). The percentage of neutrophils, platelet count, and C-reactive protein (CRP) level were higher, and the albumin (ALB) level was lower in the non-response group than that of the sensitivity group (P < 0.05). Increased neutrophil percentage and CRP level, as well as reduced ALB level, were independent risk factors for non-response (P < 0.05). Based on the areas under ROC curves, neutrophil percentage, CRP, and ALB were valuable predictors of non-response, and the cut-off values were 0.725, 78.43 mg/L, and 32.89 g/L, respectively.

Pediatricians should pay attention to possible non-response to the initial dose of IVIG in KD children with the neutrophil percentage of ≥ 0.725, CRP ≥ 78.43 mg/L, or ALB ≤ 32.89 g/L.