629 Serum Albumin Level Predicts Initial Intravenous Immunoglobulin Treatment Failure in Kawasaki Disease

Abstract

Objectives: Kawasaki disease (KD) is a systemic vasculitis primarily affecting children who are less than 5 years old. Intravenous immunoglobulin (IVIG) is the standard therapy for KD. However, many KD patients still show poor response to initial IVIG treatment. This study was conducted to investigate the risk factors for IVIG treatment failure in KD.Methods: Children who met KD diagnosis criteria and were admitted for IVIG treatment were retrospectively enrolled for analysis. Patients were divided into IVIG-responsive and IVIG-resistant groups. Initial laboratory data before IVIG treatment were collected for analysis.Results: A total of 131 patients were enrolled during the study period. At 48 h after completion of initial IVIG treatment, 20 patients (15.3%) had an elevated body temperature. Univariate analysis showed that patients who had initial findings of high neutrophil count, abnormal liver function, low serum albumin level (< 2.9 g/dL), and pericardial effusion were at risk for IVIG treatment failure. Multivariate analysis with a logistic regression procedure showed that serum albumin level was considered the independent predicting factor of IVIG resistance in KD patients (P = 0.006, OR = 40, 95% CI: 52.8- 562). There was no significant correlation between age, gender, fever duration before IVIG treatment, hemoglobin level, total leukocyte and platelet counts, C-reactive protein level, or sterile pyuria and initial IVIG treatment failure. The specificity and sensitivity for prediction of IVIG treatment failure in this study were 96% and 34%, respectively.Conclusion: Pre-IVIG treatment serum albumin levels are a useful predictor of IVIG resistance in KD patients.