Key result
Elevated neutrophils, NT-proBNP, CRP, AST, and ALT are linked to IVIG resistance in Kawasaki disease.
Why the study?
Approximately 10-15% of children with Kawasaki disease do not respond to initial IVIG and have higher risk for coronary artery lesion, but predictive laboratory factors were unclear.
Observational (n=5,151)
Yes
Odds Ratio: 1.005 (95% CI 1.002–1.007)
p-value: p=<0.001
In children with Kawasaki disease, elevated PMN, NT-proBNP, CRP, AST, and ALT predict IVIG resistance, whereas elevated CRP is specifically associated with the development of coronary artery lesions.
Lab markers may flag high-risk KD nonresponders; leaves open prospective validation before guiding therapy.
BACKGROUND AND OBJECTIVES: Approximately 10-15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD. METHODS: We retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals. RESULTS: Among 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p<0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p<0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p<0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p<0.01), while PMN, NT-proBNP, AST, and ALT were not. CONCLUSIONS: Elevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.
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Kim et al. (2017) conducted an observational in Kawasaki Disease (n=5,151). Elevated polymorphonuclear neutrophils (PMN) vs. Lower PMN levels was evaluated on IVIG resistance (OR 1.005, 95% CI 1.002-1.007, p=<0.001). Elevated levels of polymorphonuclear neutrophils, NT-proBNP, CRP, AST, and ALT were significantly associated with intravenous immunoglobulin resistance in children with Kawasaki disease.
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