Article in Japanese

Resistance to initial intravenous immunoglobulin treatment in patients with Kawasaki disease: A retrospective study

Hiroki FUJIKAWA¹⁾, Tomoki SATOU¹⁾, Shintaro FUNAKI¹⁾, Hiroyuki SHIMOZONO¹⁾, Keita MATSUBARA¹⁾

Objective: It is difficult to predict initial treatment resistance in Kawasaki disease(KD). There are 4 different sodium-containing intravenous immunoglobulin (IVIG) preparations in Japan while studies of effective IVIG products are still lacking. This study aimed to assess the predictive role of the Kobayashi score and evaluate the comparative effectiveness of 3 different types of IVIG preparations.
Methods and Results: This study retrospectively reviewed the clinical records of 473 KD patients between April 2013 and December 2017. A total of 343 patients, who had received IVIG for the first time under the main diagnosis of KD, were enrolled in this study. All of the patients were treated with high-dose IVIG (2g/kg), such as freeze-dried polyethylene glycol treated human normal immunoglobulin (Na 154 mEq/L), S-sulfonated human immunoglobulin (Na 171 mEq/L) or polyethylene glycol treated human normal immunoglobulin (Na 2.6 mEq/L). Multivariate logistic regression analysis identified serum sodium (odds ratio [OR] 4.31, 95% confidence interval [CI] 2.19-8.49), percentage of white blood cells representing neutrophils (OR 3.88, 95% CI 2.00-7.50) and aspartate aminotransferase (OR 2.77, 95% CI 1.48-5.17) as significant predictors in the Kobayashi score for resistance of IVIG. There was no significant difference in effectiveness among the IVIG preparations (p=0.16).
Conclusion: Pre-IVIG treatment serum sodium levels are most useful predictor of IVIG resistance in patients with KD. IVIG preparation containing low sodium was not associated with unresponsive IVIG.

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1) Hiroshima City Funairi Citizens Hospital

Key words	Kawasaki disease, IVIG resistance, IVIG preparations, hyponatremia, Kobayashi score
Received	July 5, 2018
Accepted	April 16, 2019

31 (3)：213─219,2019