Abstract O.38: Fever Patterns in KD Patients after Treatment with IVIG

Abstract

Objective: To determine if fever patterns in the first 36 hours after completion of intravenous immunoglobulin (IVIG) for Kawasaki disease (KD), with or without additional infliximab, can predict eventual resistance to treatment and coronary artery abnormalities (CAA). Study design: Subjects with acute KD enrolled in a clinical trial of infliximab plus IVIG (n=96) versus placebo plus IVIG (n=94) had temperatures taken axillary and either oral or rectal every 6 hours after completion of IVIG infusion. Fever was defined as any temperature > 38.0 o C and resistance to treatment was defined as persistent or recrudescent fever ≥36 hours after completion of IVIG. CAA was defined as a Z-score >2.5 based on the maximum internal diameters of the proximal right coronary or left anterior descending artery. Multivariable logistic regression was performed to predict two outcomes (resistance to treatment and development of CAA) by the variables of presence of fever at 0-12, 12-24, and 24-36 hours post IVIG. All analyses were controlled for treatment, age, and sex. Results: After completion of IVIG, 131 subjects (68.9%) had no fever. There was no difference in the median time to defervescence between the infliximab + IVIG group (n=96) versus the IVIG alone group (n= 94). Subjects who had at least one fever at 24-36 hours post-IVIG had a higher probability of having a fever at least 36 hours post-IVIG (p<0.0001, odds ratio=30.6 [95%CI 6.7-139.8]), although 11% of those who eventually responded to treatment also had fever between 24-36 hours post-completion of IVIG. Subjects who had at least one fever within the first 12 hours post-IVIG had a higher likelihood of having CAA (odds ratio=3.782, p=0.037)). Of those with CAA (n=51), 43 (84%) had abnormalities on the initial baseline echocardiogram. Conclusion: Fevers in the first 12 hours after completion of IVIG are associated with CAA, which can be demonstrated on the initial echocardiogram in the majority of CAA+ subjects. Fever 24-36 hours after IVIG completion is associated with subsequent resistance to treatment, but also occurred in 11% of responders. Our data suggest that patterns of fever can be useful as prognostic indicators of disease outcome in KD patients.