Related Factors for Sensitivity to the Initial Dose of Intravenous Immunoglobulin in Children with Kawasaki Disease

Abstract

Background: Kawasaki disease (KD) involves systemic medium- and small-vessel vasculitides, manifested as acute fever and rash. Objectives: To investigate the factors for sensitivity to the initial dose of intravenous immunoglobulin (IVIG) in children with KD. Methods: Clinical data of 222 KD children were retrospectively analyzed. Based on the response to the initial IVIG dose, they were divided into sensitivity and non-response groups. Clinical manifestations, laboratory results, and echocardiographic characteristics were compared between the study groups, and indicators with a significant difference were explored by logistic regression analysis. Receiver operating characteristic (ROC) curves were plotted using independent factors to determine the indicators for non-response. Results: Of 222 children, 181 (81.53%) were in the sensitivity group and 41 (18.47%) in the non-response group. The incidence rates of ultra-hyperpyrexia and coronary artery disease in the non-response group were significantly higher than that of the sensitivity group (P < 0.05). The percentage of neutrophils, platelet count, and C-reactive protein (CRP) level were higher, and the albumin (ALB) level was lower in the non-response group than that of the sensitivity group (P < 0.05). Increased neutrophil percentage and CRP level, as well as reduced ALB level, were independent risk factors for non-response (P < 0.05). Based on the areas under ROC curves, neutrophil percentage, CRP, and ALB were valuable predictors of non-response, and the cut-off values were 0.725, 78.43 mg/L, and 32.89 g/L, respectively. Conclusions: Pediatricians should pay attention to possible non-response to the initial dose of IVIG in KD children with the neutrophil percentage of ≥ 0.725, CRP ≥ 78.43 mg/L, or ALB ≤ 32.89 g/L.