Abstract
Few studies have compared the effects of low-concentration (5%) and high-concentration (10%) intravenous immunoglobulin (IVIG) preparations for patients with Kawasaki disease (KD) in the acute phase. The purpose of this study was to compare outcomes between low- and high-concentration IVIG preparations in children with KD, using a national inpatient database in Japan. We used the Diagnostic Procedure Combination database to identify patients with KD treated with IVIG from April 2012 to March 2020. We identified those receiving high- and low-concentration IVIG preparations as an initial treatment. The outcomes included the proportions of patients with coronary artery abnormalities (CAAs) and IVIG resistance, length of stay, and medical costs. Propensity score-matched analyses were conducted to compare the outcomes between the 2 groups. Instrumental variable analyses were performed to confirm the results. We identified 48046 patients with KD and created 4:1 propensity score-matched pairs between the low- and high-concentration IVIG groups. There was a significant difference in the percentage with IVIG resistance between the 2 groups (20.6% vs 24.1%; risk difference, 3.5% [95% confidence interval, 2.3-4.7]; P<.001). However, there was no significant difference in CAAs (1.6% vs 1.6%; risk difference, 0.013% [95% confidence interval, -0.34 to 0.37]; P=.953). The instrumental variable analyses showed similar results. The proportion of CAAs did not differ significantly between those receiving low- and high-concentration IVIG. To confirm the results of this study, prospective studies adjusting for duration of IVIG administration and duration of observation are needed.
Highlights
Kawasaki disease (KD), which is acute systemic vasculitis, is the most common cause of acquired heart disease in children in developed countries.[1]
To confirm the results of this study, prospective studies adjusting for duration of intravenous immunoglobulin (IVIG) administration and duration of observation are needed
Study population We identified a total of 48,046 patients with KD who met the inclusion criteria, including 42,133 patients with 5% IVIG and 5913 patients with 10% IVIG as the initial treatment in the acute phase (Fig. 1)
Summary
Kawasaki disease (KD), which is acute systemic vasculitis, is the most common cause of acquired heart disease in children in developed countries.[1]. Since January 2013, 10% IVIG preparations began to be used in Japan to treat patients with KD in the acute phase. No studies have evaluated the proportion of patients with IVIG resistance or coronary artery abnormalities (CAAs), length of stay, medical costs, or complications by different concentrations of IVIG. The purpose of this study was to compare the outcomes of children with KD treated with low-concentration (5%) and high-concentration (10%) IVIG preparations, using a national inpatient database in Japan. - For treatments of Kawasaki Disease in acute phase, intravenous immunoglobulin (IVIG) has been the most recommended to reduce fever early and prevent complications of coronary artery abnormalities.
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