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Prediction of responsiveness or non-responsiveness to treatment of acute Kawasaki disease using 1 gram per kilogram of immunoglobulin – an effective and cost-saving schedule of therapy

Published online by Cambridge University Press:  10 March 2009

Ko Ichihashi ,
Hirohiko Shiraishi  and
Mariko Momoi
Ko Ichihashi*
Affiliation:
Department of Pediatrics, Saitama Medical Center of Jichi Medical University, Saitama, Japan
Hirohiko Shiraishi
Affiliation:
Department of Pediatrics, Jichi Medical University, Tochigi, Japan
Mariko Momoi
Affiliation:
Department of Pediatrics, Jichi Medical University, Tochigi, Japan
*
Correspondence to: Ko Ichihashi, Department of Pediatrics, Saitama Medical Center of Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503Japan. Tel: +81-48-647-2111; Fax: +81-48-648-5188; E-mail: [email protected]
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Abstract

Standard treatment of acute Kawasaki disease involves giving 2 grams per kilogram of immunoglobulin intravenously along with aspirin. More than half of the patients with acute Kawasaki disease, nonetheless, can be cured by giving only 1 gram per kilogram of immunoglobulin, thus reducing this aspect of the cost of treatment by half. Our purpose was to predict those patients with acute Kawasaki disease who would respond to treatment with 1 gram per kilogram of immunoglobulin given intravenously on the basis of their clinical profiles and laboratory findings prior to the initial treatment. We performed a retrospective review of the clinical records of consecutive patients with acute Kawasaki disease treated in our hospital with intravenous immunoglobulin from January, 2001, to December, 2005.

During this period, we treated in this fashion 98 patients with acute Kawasaki disease. 65% of these needing immunoglobulin therapy were cured by giving 1 gram per kilogram. The neutrophil count and the percentage of white blood cells representing neutrophils, along with aspirate aminotransferase, alanine aminotransferase, bilirubin and C reactive protein, were all significantly lower, and sodium was significantly higher, in those responding to 1 gram per kilogram of immunoglobulin when compared to those who did not respond. The days of illness at the first intravenous treatment was later in those responding than in those failing to respond. We generated a score for prediction, assigning a point for each of C reactive protein equal to or greater than 10 mg/dl, sodium equal to or lower than 133 meq/l, alanine aminotransferase equal to or greater than 110 IU/l, and 2 points for the percentage of white blood cells representing neutrophils equal to or greater than 70%. Using a cut-off point of a score less than 2, we were able to identify those responding with 60% sensitivity, and 91% specificity.

Thus, we are now able to predict those patients with acute Kawasaki disease who will respond to immunoglobulin given intravenously at 1 gram per kilogram using laboratory data, with a potential saving in medical costs.

Keywords

Mucocutaneous lymph node syndromeprediction scorestratified therapycost performance
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 3 , June 2009 , pp. 224 - 227
Copyright
Copyright © Cambridge University Press 2009

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References

1. Kawasaki, T, Kosaki, F, Okawa, S, Shigematsu, I, Yanagawa, H. A new infantile acute febrile mucocutaneous lymph node syndrome (MCLS) prevailing in Japan. Pediatrics 1974; 54: 271–276.CrossRefGoogle ScholarPubMed
2. Yanagawa, H, Nakamura, Y, Yashiro, M, et al. Incidence of Kawasaki disease in Japan: the nationwide surveys of 1999–2002. Pediatr Int 2006; 48: 336–361.CrossRefGoogle ScholarPubMed
3. Harada, K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991; 33: 805–810.CrossRefGoogle ScholarPubMed
4. Ayusawa, M, Sonobe, T, Uemura, S, et al. . Kawasaki Disease Research Committee. Revision of diagnostic guidlines for Kawasaki disease (the 5th revised edition). Pediatr Int 2005; 47: 232–234.CrossRefGoogle Scholar
5. Research Committee on Kawasaki Disease. Report of the Subcommittee on Standardization of Diagnostic Criteria and Reporting of Coronary Artery Lesions in Kawasaki Disease. Minister of Health and Welfare, Tokyo, 1984.Google Scholar
6. Dajani, AS, Taubert, KA, Takahashi, M, et al. Guidlines for long term management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki disease. Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994; 89: 916–922.CrossRefGoogle Scholar
7. Durongopisitkul, K, Gururaj, VJ, Park, JM, Martin, CF. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995; 96: 1057–1061.CrossRefGoogle Scholar
8. Terai, M, Shulman, ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997; 131: 888–893.CrossRefGoogle ScholarPubMed
9. Muta, H, Ishii, M, Furui, J, Nakamura, Y, Matsuishi, . Risk factors associated with the need for additional intravenous gamma-globulin therapy for Kawasaki disease. Acta Paediatr 2006; 95: 189–193.Google ScholarPubMed
10. Asai, T. Evaluation method for the degree of seriousness in Kawasaki disease. Acta Paediatr Jpn 1983; 25: 170–175.CrossRefGoogle Scholar
11. Iwasa, M, Sugiyama, K, Ando, T, et al. Selection of high-risk children for immunoglobulin therapy in Kawasaki disease. Prog Clin Biol Res 1987; 250: 543–544.Google ScholarPubMed
12. Fukunishi, M, Kikawa, M, Hamana, K, et al. Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 2000; 137: 172–176.CrossRefGoogle ScholarPubMed
13. Sano, T, Kurotobi, S, Matsuzaki, K, et al. Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 2007; 166: 131–137.CrossRefGoogle ScholarPubMed
14. Kobayashi, T, Inoue, Y, Takeuchi, K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006; 113: 2606–2612.CrossRefGoogle ScholarPubMed