Abstract Objective To examine the association between duration of fever before intravenous immunoglobulin (IVIG) treatment and IVIG resistance in children with Kawasaki disease (KD). Methods A retrospective analysis was performed on the medical data of 317 children with KD who were admitted from January 2018 to December 2020. According to the duration of fever before IVIG treatment, they were divided into two groups: short fever duration group (≤4 days) with 92 children and long fever duration group (>4 days) with 225 children. According to the presence or absence of IVIG resistance, each group was further divided into a drug-resistance group and a non-drug-resistance group. Baseline data and laboratory results were compared between groups. A multivariate logistic regression analysis was used to identify the influencing factors for IVIG resistance. Results In the short fever duration group, 19 children (20.7%) had IVIG resistance and 5 children (5.4%) had coronary artery aneurysm, and in the long fever duration group, 22 children (9.8%) had IVIG resistance and 19 children (8.4%) had coronary artery aneurysm, suggesting that the short fever duration group had a significantly higher rate of IVIG resistance than the long fever duration group (P<0.05), while there was no significant difference in the incidence rate of coronary artery aneurysm between the two groups (P>0.05). In the short fever duration group, compared with the children without drug resistance, the children with drug resistance had a significantly lower level of blood sodium and significantly higher levels of procalcitonin, C-reactive protein, and N-terminal B-type natriuretic peptide before treatment (P<0.05). In the long fever duration group, the children with drug resistance had significantly lower levels of blood sodium and creatine kinase before treatment than those without drug resistance (P<0.05). The multivariate logistic regression analysis showed that a reduction in blood sodium level was associated with IVIG resistance in the long fever duration group (P<0.05). Conclusions IVIG resistance in children with KD varies with the duration of fever before treatment. A reduction in blood sodium is associated with IVIG resistance in KD children with a duration of fever of >4 days before treatment.
WANG Xin,PAN Si-Lin,DU Zhan-Hui et al. Association between duration of fever before treatment and intravenous immunoglobulin resistance in Kawasaki disease[J]. CJCP, 2022, 24(4): 399-404.
WANG Xin,PAN Si-Lin,DU Zhan-Hui et al. Association between duration of fever before treatment and intravenous immunoglobulin resistance in Kawasaki disease[J]. CJCP, 2022, 24(4): 399-404.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease[J]. Circulation, 2006, 113(22): 2606-2612. PMID: 16735679. DOI: 10.1161/CIRCULATIONAHA.105.592865.
Sittiwangkul R, Pongprot Y, Silvilairat S, et al. Delayed diagnosis of Kawasaki disease: risk factors and outcome of treatment[J]. Ann Trop Paediatr, 2011, 31(2): 109-114. PMID: 21575314. DOI: 10.1179/1465328111Y.0000000005.
Shiozawa Y, Inuzuka R, Shindo T, et al. Effect of i.v. immunoglobulin in the first 4 days of illness in Kawasaki disease[J]. Pediatr Int, 2018, 60(4): 334-341. PMID: 29292568. DOI: 10.1111/ped.13512.
Li W, He X, Zhang L, et al. A retrospective cohort study of intravenous immunoglobulin therapy in the acute phase of Kawasaki disease: the earlier, the better?[J]. Cardiovasc Ther, 2021, 2021: 6660407. PMID: 34239607. PMCID: PMC8233071. DOI: 10.1155/2021/6660407.
Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease[J]. J Pediatr, 2006, 149(2): 237-240. PMID: 16887442. DOI: 10.1016/j.jpeds.2006.03.050.
Sano T, Kurotobi S, Matsuzaki K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment[J]. Eur J Pediatr, 2007, 166(2): 131-137. PMID: 16896641. DOI: 10.1007/s00431-006-0223-z.
Edraki MR, Mohammadi H, Mehdizadegan N, et al. Japanese Kawasaki disease scoring systems: are they applicable to the Iranian population?[J]. Arch Iran Med, 2020, 23(1): 31-36. PMID: 31910632.
Ha KS, Lee J, Lee KC. Prediction of intravenous immunoglobulin resistance in patients with Kawasaki disease according to the duration of illness prior to treatment[J]. Eur J Pediatr, 2020, 179(2): 257-264. PMID: 31713683. DOI: 10.1007/s00431-019-03474-w.
Miura K, Harita Y, Takahashi N, et al. Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease[J]. Pediatr Int, 2020, 62(3): 363-370. PMID: 31657491. DOI: 10.1111/ped.14036.
Wu Y, Liu FF, Xu Y, et al. Interleukin-6 is prone to be a candidate biomarker for predicting incomplete and IVIG nonresponsive Kawasaki disease rather than coronary artery aneurysm[J]. Clin Exp Med, 2019, 19(2): 173-181. PMID: 30617865. DOI: 10.1007/s10238-018-00544-5.
Kim JH, Park JH, Eisenhut M, et al. Inflammasome activation by cell volume regulation and inflammation-associated hyponatremia: a vicious cycle[J]. Med Hypotheses, 2016, 93: 117-121. PMID: 27372869. DOI: 10.1016/j.mehy.2016.05.018.
Masuda H, Ae R, Koshimizu TA, et al. Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease[J]. Clin Rheumatol, 2022, 41(1): 137-145. PMID: 34363547. DOI: 10.1007/s10067-021-05881-7.
