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Korean J Pediatr 2016 April;59(4) :178-182.
Published online 2016 April 15.       
Prediction of nonresponsiveness to medium-dose intravenous immunoglobulin (1 g/kg) treatment: an effective and safe schedule of acute treatment for Kawasaki disease
Kyung Pil Moon, Beom Joon Kim, Kyu Jin Lee, Jin Hee Oh, Ji Whan Han, Kyung Yil Lee, Soon Ju Lee
Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
Corresponding Author: Soon Ju Lee ,Tel: +82-32-340-7046, Fax: +82-32-340-2673, Email:
Copyright © 2016 by The Korean Pediatric Society
Purpose: Medium-dose (1 g/kg) intravenous immunoglobulin (IVIG) is effective in the majority of patients with Kawasaki disease (KD) but some patients who do not respond to medium-dose IVIG are at high risk for the development of coronary artery lesions (CALs). The purpose of this study was to identify the clinical predictors associated with unresponsiveness to medium-dose IVIG and the development of CALs.
Methods: A retrospective study was performed in 91 children with KD who were treated with medium-dose IVIG at our institution from January 2004 to December 2013. We classified the patients into responders (group 1; n=68) and nonresponders (group 2; n=23). We compared demographic, laboratory, and echocardiographic data between the 2 groups.
Results: Multivariate logistic regression analysis identified 6 variables as predictors for resistance to medium-dose IVIG. We generated a predictive scoring system assigning 1 point each for percentage of neutrophils 65%, C-reactive protein100 mg/L, aspartate aminotransferase100 IU/L, and alanine aminotransferase100 IU/L, as well as 2 points for less than 5 days of illness, and serum sodium level136 mmol/L. Using a cutoff point of 4 with this scoring system, we could predict nonresponsiveness to medium-dose IVIG with 74% sensitivity and 71% specificity.
Conclusion: If a patient has a low-risk score in this system, medium-dose IVIG can be recommended as the initial treatment. Through this process, we can minimize the adverse effects of high-dose IVIG and incidence of CALs.
Keywords: Kawasaki disease | Medium-dose intravenous immunoglobulins | Coronary artery
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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)
Meta-analysis of factors predicting resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease  2016 February;59(2)
Predictors of nonresponse to intravenous immunoglobulin therapy in Kawasaki disease  2013 February;56(2)
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