Evaluation of intravenous immunoglobulin resistance and coronary artery lesions in relation to Th1/Th2 cytokine profiles in patients with Kawasaki disease

AbstractObjectiveTo determine the optimal drug therapy for intravenous immunoglobulin-resistant Kawasaki disease.MethodsStudies regarding drug therapy for intravenous immunoglobulin-resistant Kawasaki disease were selected from medical electronic databases including PubMed, Medline, Elsevier, and Springer Link. The effectiveness in terms of temperature recovery and coronary artery damage was compared between a second intravenous immunoglobulin treatment and glucocorticosteroid treatment for children with intravenous immunoglobulin-resistant Kawasaki disease using meta-analysis with Review Manager 5.3 software. Indices to evaluate the effects were body temperature, biomarker levels, and coronary artery lesions detected by echocardiography. Results are reported as relative risks or odds ratio with a 95% confidence interval and p<0.05.ResultsMeta-analysis included 52 patients in the second intravenous immunoglobulin treatment group and 75 patients in the glucocorticosteroid treatment control group from four studies that met our inclusion criteria. Temperatures of patients who received glucocorticosteroid treatment were effectively controlled compared with those who received a second intravenous immunoglobulin treatment (relative risk=0.73, 95% confidence interval: 0.58–0.92, p=0.007). There were no differences, however, in the incidence of coronary artery lesions between the two groups (odds ratio=1.55, 95% confidence interval: 0.57–4.20, p=0.39).ConclusionsGlucocorticosteroids are more effective in controlling body temperature compared with intravenous immunoglobulin re-treatment in intravenous immunoglobulin-resistant Kawasaki disease children; however, glucocorticosteroids and intravenous immunoglobulin re-treatment showed no difference in the prevention of coronary artery lesions.

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Low-Dose Methylprednisolone Therapy for Intravenous Immunoglobulin-Resistant Kawasaki Disease

10.21203/rs.3.rs-279443/v1 ◽

2021 ◽

Author(s):

Yibo Zhuang ◽

Hongxue Zheng ◽

Lingtao Zhu

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brain Natriuretic Peptide ◽

Effective Treatment ◽

Intravenous Immunoglobulin ◽

Low Dose ◽

Coronary Artery Lesions ◽

Intravenous Methylprednisolone ◽

Unsuccessful Treatment ◽

Electrochemiluminescence Immunoassay

Abstract Background The dose of methylprednisolone therapy for intravenous immunoglobulin-resistant Kawasaki disease (IVIG-resistant KD) remains controversial. The study aims to investigate the effect of low-dose intravenous methylprednisolone (IVMP) therapy on children with IVIG-resistant KD. Methods 36 IVIG-resistant KD children were recruited. Coronary artery lesions (CAL) were recorded before these children were first treated with IVIG. 15 patients were treated with a second course of IVIG (2 g/kg/dose) after unsuccessful treatment with IVIG (2 g/kg/dose), named IVIG group. 21 patients with IVIG-resistant KD were treated with a second course of IVIG and low-dose IVMP (2 mg/kg/day) for 3-5 days after unsuccessful treatment with IVIG, named IVIG+IVMP group, including 8 patients with CAL and 13 patients without CAL. The level of brain natriuretic peptide (BNP) in serum was detected by electrochemiluminescence immunoassay. Results The treatment was successful in 21 (100%) of the patients who received additional IVIG along with IVMP and 10 (66.7%) who received additional IVIG. In IVIG+IVMP group, BNP decreased significantly after patients received additional IVIG along with IVMP. 72h After treated with additional IVIG and IVMP, there was no difference of BNP levels between patients with CAL and without CAL in IVIG+IVMP group. None of the patients was with CAL followed up for 1 year in IVIG+IVMP group.Conclusion This study suggest that low-dose IVMP along with additional IVIG is an effective treatment for IVIG-resistant KD, and low-dose IVMP increases no risk of CAL.

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Predictive value of serum lipid for intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab230 ◽

2021 ◽

Author(s):

Shuran Shao ◽

Kaiyu Zhou ◽

Xiaoliang Liu ◽

Lei Liu ◽

Mei Wu ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Lipid Profile ◽

Intravenous Immunoglobulin ◽

Predictive Value ◽

University Hospital ◽

West China ◽

Ivig Resistance ◽

Intravenous Immunoglobulin Resistance ◽

Resistant Group

Abstract Context Intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) prediction are pivotal topic of interests in Kawasaki disease (KD). However, data on the predictive value of lipid profile for both IVIG resistance and CALs are limited. Purpose To investigate the predictive validity of lipid profile for IVIG resistance and CALs in KD. Design Prospective cohort study. Setting West China Second University Hospital. Patients 363 KD patients were divided into the initial IVIG-resistant group and initial IVIG-responsive group; repeated IVIG-resistant group and repeated IVIG-responsive group; CAL+ group and CAL- group. Main Outcome Measures Validity of lipid profile in predicting IVIG resistance and CALs. Results TG was significantly higher whereas TC, HDL-C, LDL-C as well as Apo A were significantly lower in initial IVIG-resistant subjects, with cut-off values of 1.625 mmol/L, 3.255 mmol/L, 0.475 mmol/L, and 1.965 mmol/L and 0.665 g/L, yielding sensitivities of 52%, 70%, 52%, 61%, 50%, and specificities of 68%, 53%, 78%, 71%, 81%, respectively. TC, LDL-C, and Apo A levels were significantly lower in repeated IVIG-resistant subjects, with cut-off values of 3.20 mmol/L, 1.78 mmol/L, 0.605 g/L, producing sensitivities of 91%, 70%, 57% and specificities of 55%, 67%, 70%, respectively. Apo-A level was significantly lower in the CAL group, with cut-off value of 0.805g/L, yielding sensitivity of 66% and specificity of 54%. Conclusions Lipid profiles were significantly dysregulated in KD patients suffering IVIG resistance and CALs. Some of them, such as LDL-c and Apo-A, could serve as complementary laboratory markers for predicting both IVIG resistance and CALs.

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