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Journal of Advances in Medicine and Medical Research, ISSN: 2456-8899, ISSN: 2231-0614 (Past),Vol.: 23, Issue.: 2

Original-research-article

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.

Article Information

Editor(s):

(1) Chris Ekpenyong, Department of Human Physiology, College of Health Sciences, University of Uyo, Nigeria.

Reviewers:

(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

Abstracts

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.

Keywords :

Kawasaki disease; intravenous immunoglobulin therapy; C-reactive protein; neutrophil; coronary artery lesions.

Full Article - PDF    Page 1-8

DOI : 10.9734/JAMMR/2017/35081

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