Journal of Advances in Medicine and Medical Research, ISSN: 2456-8899, ISSN: 2231-0614 (Past),Vol.: 23, Issue.: 2
Parameters to Guide Rescue Therapy for Intravenous Immunoglobulin-resistant Kawasaki Disease
Toshimasa Nakada1* 1Department of Pediatrics, Aomori Prefectural Central Hospital,〒030-8553 Higashi-Tukurimiti 2-1-1, Aomori City, Aomori Prefecture, Japan.
1Department of Pediatrics, Aomori Prefectural Central Hospital,〒030-8553 Higashi-Tukurimiti 2-1-1, Aomori City, Aomori Prefecture, Japan.
(1) Chris Ekpenyong, Department of Human Physiology, College of Health Sciences, University of Uyo, Nigeria.
(1) Sanja Javor, University Hospital San Martino, Italy.
(2) Essam A. El-Moselhy, Al-Azhar University, Egypt.
(3) Piero Valentini, Catholic University of the Sacred Heart, Italy.
Complete Peer review History: http://www.sciencedomain.org/review-history/20214
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 C-reactive 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.
Kawasaki disease; intravenous immunoglobulin therapy; C-reactive protein; neutrophil; coronary artery lesions.
Full Article - PDF Page 1-8
DOI : 10.9734/JAMMR/2017/35081Review History Comments