Neutropenia after intravenous immunoglobulin therapy is associated with coronary artery lesions in children with Kawasaki disease: a case control study

Rongzhou Wu,Yue’e He,Hongying Shi,Maoping Chu,Zhenquan Wang,Huixian Qiu,Zhangke Tang,Fengfeng Weng,Chen Li

doi:10.1186/s12887-018-1032-z

Abstract

BackgroundTo evaluate differences in laboratory parameters, clinical presentation, and incidence of coronary artery lesions (CAL) between children with neutropenic and non-neutropenic Kawasaki disease (KD).MethodsAll consecutive KD patients that presented to the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, China between January 2005 and December 2015 were included in this study. Patients were divided into two groups (KD with neutropenia (NKD) and KD without neutropenia (NNKD)) based on whether or not they developed neutropenia during the course of treatment. We compared differences in clinical manifestations, laboratory parameters, and treatment protocols between groups. We also evaluated the relationship between neutropenia with immunoglobulin dosage and incidence of CAL.ResultsAn IVIG treatment regimen of 2 g/kg*1d was associated with a lower incidence of neutropenia compared to the 1 g/kg*2d protocol. The incidence of CAL was higher in KD patients with neutropenia than in those without. Subgroup analysis showed no difference in the incidence of CAL among the different age groups between KD patients with and without neutropenia.ConclusionsFollow up ultrasonic echocardiography should be performed in KD patients with neutropenia in order to allow for early detection of CAL and timely intervention.

Highlights

To evaluate differences in laboratory parameters, clinical presentation, and incidence of coronary artery lesions (CAL) between children with neutropenic and non-neutropenic Kawasaki disease (KD)
We found that (1) neutropenic KD patients had lower white blood cell count (WBC) and Absolute neutrophil count (ANC) levels in the acute phase after Intravenous immune globulin (IVIG) treatment (P = 0.028 and P = 0.002, respectively); (2) there was a greater reduction in ANC levels in the NKD group than the NNKD group (P = 0.001); and (3) D-Dimer, FIB and prothrombin time (PT) were lower in the NKD group than in the NNKD group (P = 0.002, P = 0.004, and P = 0.001, respectively)
We found that (1) IVIG treatment duration differed between the two groups, being longer in the NKD than the NNKD group (P = 0.002); (2) the incidence of neutropenia in children treated with the 2 g/kg*1d scheme was lower than in those treated with 1 g/kg*2d (P = 0.009); (3) in patients followed up with ultrasonic echocardiography (UCG) for 3 months after IVIG treatment, the incidence of CAL was higher in the NKD group than in the NNKD group (P = 0.008); and (4) the probability of male patients with neutropenia in the NKD was higher than that in the NNKD group, but there’s no sex differences between groups (P = 0.715) (Table 2)

Summary

Introduction

To evaluate differences in laboratory parameters, clinical presentation, and incidence of coronary artery lesions (CAL) between children with neutropenic and non-neutropenic Kawasaki disease (KD). Patients were divided into two groups (KD with neutropenia (NKD) and KD without neutropenia (NNKD)) based on whether or not they developed neutropenia during the course of treatment. We compared differences in clinical manifestations, laboratory parameters, and treatment protocols between groups. Neutrophils play an important role in the pathogenesis of KD, as raised neutrophil levels during the course of disease have been shown to be related to the pathogenesis of KD and CAL [4]. The aim of this study was to 1) investigate the effect of IVIG in patients with neutropenic KD (NKD) and non-neutropenic KD

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Discussion

Conclusion