Does The Administered Salicylate Dose Predict IVIG Treatment Failure in Kawasaki Disease?

Abstract

A sub-group of KD patients fails initial IVIG treatment, develops persistent or recurrent fever and inflammatory signs, and require repeat IVIG or other therapy. Factors contributing to IVIG treatment failure are incompletely understood. We hypothesized that administering lower aspirin doses contributes to initial IVIG treatment failure. Methods: From our database of 394 KD patients treated from 1992-2001, we identified those who received more than one 2gm/kg dose of IVIG. Each was matched with two KD controls by gender, age and illness day at initial IVIG treatment. Data regarding clinical and echocardiographic features, aspirin dosing, and laboratory findings were were assessed and compared for retreated patients and matched controls. Results: 26 patients (6.5%) had been treated with more than one 2gm/kg dose of IVIG, including 20 who were retreated once and six retreated twice. Fifty matched controls were identified. There was no significant difference between patients and matched controls with respect to age, gender, day of illness of initial treatment, and pre-treatment WBC, absolute band count, hemoglobin, albumin, and ESR. Retreated patients had significantly higher pre-preatment absolute neutrophil counts (P=0.008) and total bilirubin levels (P=0.009). No differences in KD presenting clinical features between retreated patients and matched controls, except that peripheral desquamation was noted more often in retreated patients (p=0.043). Although marked differences in aspirin dosing were not observed, a significantly greater proportion of retreated patients than matched controls were initially treated with < 80 mg/kg ASA (35% vs. 12%, respectively [P=0.022] on the first treatment day, 36% vs. 12% on the second treatment day [p=0.020], and 32% vs. 14% on the third treatment day [P=0.086]). Retreated patients had abnormal echocardiograms more foten than mathed controls (p=0.027), mainly reflecting baseline abnormalities. We conclude that lower administered initial doses of ASA may contribulte to IVIG treatment failure and thus to consequent need for retreatment and possibly poorer echocardiographic outcomes.