Advanced Search
Korean J Pediatr 2016 February;59(2) :80-90.
Published online 2016 February 15.       
Meta-analysis of factors predicting resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease
Jin-Young Baek1, Min Seob Song2
1Department of Pediatrics, Good GangAn Hospital, Busan, Korea
2Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
Corresponding Author: Min Seob Song ,Tel: +82-51-797-0652, Fax: +82-51-797-0649, Email:
Copyright © 2016 by The Korean Pediatric Society
Purpose: Studies have been conducted to identify predictive factors of resistance to intravenous immunoglobulin (IVIG) for Kawasaki disease (KD). However, the results are conflicting. This study aimed to identify laboratory factors predictive of resistance to high-dose IVIG for KD by performing meta-analysis of available studies using statistical techniques.
Methods: All relevant scientific publications from 2006 to 2014 were identified through PubMed searches. For studies in English on KD and IVIG resistance, predictive factors were included. A meta-analysis was performed that calculated the effect size of various laboratory parameters as predictive factors for IVIG-resistant KD.
Results: Twelve studies comprising 2,745 patients were included. Meta-analysis demonstrated significant effect sizes for several laboratory parameters: polymorphonuclear leukocytes (PMNs) 0.698 (95% confidence interval [CI], 0.469–0.926), C-reactive protein (CRP) 0.375 (95% CI, 0.086–0.663), pro-brain natriuretic peptide (pro-BNP) 0.561 (95% CI, 0.261–0.861), total bilirubin 0.859 (95% CI, 0.582–1.136), alanine aminotransferase (AST) 0.503 (95% CI, 0.313–0.693), aspartate aminotransferase (ALT) 0.436 (95% CI, 0.275–0.597), albumin 0.427 (95% CI, –0.657 to –0.198), and sodium 0.604 (95% CI, –0.839 to –0.370). Particularly, total bilirubin, PMN, sodium, pro-BNP, and AST, in descending numerical order, demonstrated more than a medium effect size.
Conclusion: Based on the results of this study, laboratory predictive factors for IVIG-resistant KD included higher total bilirubin, PMN, pro-BNP, AST, ALT, and CRP, and lower sodium and albumin. The presence of several of these predictive factors should alert clinicians to the increased likelihood that the patient may not respond adequately to initial IVIG therapy.
Keywords: Mucocutaneous lymph node syndrome | Intravenous immunoglobulins | Predictive value of tests | Meta-analysis
PDF Links  PDF Links
Full text via DOI  Full text via DOI
Download Citation  Download Citation
Supplementary Material  Supplementary Material
Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease  2017 July;60(7)
Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease  2016 December;59(12)
Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment  2016 October;59(10)
Prediction of nonresponsiveness to medium-dose intravenous immunoglobulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease  2016 April;59(4)
Sensorineural hearing loss in patients with Kawasaki disease  2015 November;58(11)
Register for e-submission
Register here to access the e-submission system of Korean J Pediatr for authors and reviewers.
Manuscript Submission
To submit a manuscript, please visit the Korean J Pediatr e-submission management system at, read the Instructions for Authors, and log into the Korean J Pediatr e-submission system. For assistance with manuscript submission, please contact:
Free archive
Anyone may access any past or current articles without logging in.
Korean Pediatric Society Office
#1606, Seocho World Officetel, 19 Seoun-ro, Seocho-gu, Seoul 137-070, Korea
TEL : +82-2-3473-7305    FAX : +82-2-3473-7307   E-mail:
BrowseCurrent IssueFor Authors and ReviewersAbout
Copyright© The Korean Pediatric Society. All right reserved.