scholarly journals The “Intermediate” CD14 + CD16 + monocyte subpopulation plays a role in IVIG responsiveness of children with Kawasaki disease

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi Seul Kim ◽  
Hyun Jin Yang ◽  
Seung-Jung Kee ◽  
Insu Choi ◽  
Kisoo Ha ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Laboratory Tests ◽  
Febrile Illness ◽  
Cardiac Complications ◽  
Study Cohort ◽  
Ivig Infusion ◽  
Functional Studies ◽  
Ivig Resistance ◽  
Resistant Group ◽  
Intermediate Monocytes

Abstract Background Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause. Intravenous immunoglobulin (IVIG)-resistance are related to greater risk for permanent cardiac complications. We aimed to determine the correlation between monocytes and the phenotype of KD in relation to IVIG responsiveness in children. Materials and methods The study cohort included 62 patients who were diagnosed with KD, 20 non febrile healthy controls (NFC), and 15 other febrile controls (OFC). In all enrolled patients, blood was taken at least 4 times and laboratory tests were performed. In addition, subtypes of monocytes were characterized via flow cytometry. Results The numbers of intermediate monocytes were significantly lower in IVIG-resistant group compared to IVIG-responsive group before IVIG infusion (p < 0.0001). After infusion, intermediate monocytes decreased in the responsive group, while a trend of increase was observed in the resistant group. Only intermediate monocytes were significant in logistic regression with adjusted OR of 0.001 and p value of 0.03. Conclusions CD14 + CD16 + intermediate monocyte may play an important role in IVIG responsiveness among KD children. Low starting levels of intermediate monocytes, followed by a dramatic increase post-IVIG infusion during acute phase of KD are associated with IVIG-resistance. Functional studies on intermediate monocyte may help to reveal the pathophysiology.

scholarly journals The Intermediate CD14+CD16+ Monocyte Subpopulation Plays a Role in IVIG Responsiveness of Children with Kawasaki Disease

2020 ◽  
Author(s):  
Yi Seul Kim ◽  
Hyun Jin Yang ◽  
Insu Choi ◽  
Kisoo Ha ◽  
Katrina K Ki ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Febrile Illness ◽  
Cardiac Complications ◽  
P Value ◽  
Study Cohort ◽  
Ivig Infusion ◽  
Functional Studies ◽  
Ivig Resistance ◽  
Resistant Group ◽  
Intermediate Monocytes

Abstract Background: Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause. Intravenous immunoglobulin (IVIG)-resistance are related to greater risk for permanent cardiac complications. We aimed to determine the correlation between monocytes and the phenotype of KD in relation to IVIG responsiveness in children. Materials and Methods: The study cohort included 62 patients who were diagnosed with KD, 20 non febrile healthy controls (NFC), and 15 other febrile controls (OFC). In all enrolled patients, blood was taken at least 4 times and laboratory tests were performed. In addition, subtypes of monocytes were characterized via flow cytometry. Results: The numbers of intermediate monocytes were significantly lower in IVIG-resistant group compared to IVIG-responsive group before IVIG infusion (p<0.0001). After infusion, intermediate monocytes decreased in the responsive group, while a trend of increase was observed in the resistant group. Only intermediate monocytes were significant in logistic regression with adjusted OR of 0.001 and p value of 0.03. Conclusions: CD14+CD16+ intermediate monocyte may play an important role in IVIG responsiveness among KD children. Low starting levels of intermediate monocytes, followed by a dramatic increase post-IVIG infusion during acute phase of KD are associated with IVIG-resistance. Functional studies on intermediate monocyte may help to reveal the pathophysiology.

scholarly journals Predictive Value of Albumin-Bilirubin Grade For Intravenous Immunoglobulin Resistance In A Large Cohort Of Patients With Kawasaki Disease: A Prospective Study

2021 ◽  
Author(s):  
Yu Yan ◽  
Lina Qiao ◽  
Shuran Shao ◽  
Nanjun Zhang ◽  
Mei Wu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Predictive Value ◽  
Independent Risk Factor ◽  
Laboratory Data ◽  
Multivariate Logistic Regression Analysis ◽  
Predictive Ability ◽  
Ivig Infusion ◽  
Ivig Resistance

Abstract Background: Intravenous immunoglobulin (IVIG) resistance, which defined that Kawasaki disease (KD) patients have recrudescence fever more than 36 hours after IVIG infusion, and its prediction is one of the primary clinical issues and study hotspots in KD. This study aimed to prospectively investigated the value of albumin-bilirubin grade (ALBI) in predicting IVIG resistance in KD, and assessed whether ALBI has more predictive value or accuracy than either ALB or TBil alone in predicting IVIG resistance.Methods: A total of 823 patients with KD were prospectively enrolled. The clinical and laboratory data were compared between IVIG-response group (n=708) and IVIG-resistance group (n=115). Multivariate logistic regression analysis was performed to identify the independent risk factors of IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of ALBI, ALB, and TBil in predicting IVIG resistance. Results: ALBI was significantly higher in patients with IVIG resistance and was identified as an independent risk factor for IVIG resistance in KD. The parameter of ALBI ≥ –2.57 (AUC: 0.705, 95%CI: 0.672–0.736), ALB ≤ 33.0g/L (AUC: 0.659, 95%CI: 0.626–0.692), and TBil ≥16.0μmol/L (AUC: 0.626, 95%CI: 0.592–0.659), produced a sensitivity, specificity, PPV, and NPV of 0.617, 0.657, 0.226, 0.914, and 0.651; 0.374, 0.850, 0.289, 0.893, and 0.783; 0.269, 0.941, 0.425, 0.888, and 0.847, respectively.Conclusion: A higher ALBI was an independent risk factor for IVIG resistance. It yielded better predictive ability than ALB and TBil alone for initial IVIG resistance.

scholarly journals Prediction of Repeated Intravenous Immunoglobulin Resistance in Children With Kawasaki Disease

2021 ◽  
Author(s):  
Yaheng Lu ◽  
Tingting Chen ◽  
Yizhou Wen ◽  
Feifei Si ◽  
Xindan Wu ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Ivig Treatment ◽  
Roc Curve Analysis ◽  
Ivig Resistance ◽  
Intravenous Immunoglobulin Resistance ◽  
Resistant Group ◽  
Resistance Prediction

Abstract Background: Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD.Methods: A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis.Results: The laboratory data of the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium (Na+) and albumin (ALB) were significantly lower (P<0.05). The clinic data showed no significant differences between the two groups. PCT exhibited the largest AUC (0.751) in predicting repeated IVIG resistance in KD compared with N%, Na+, ALB, and NT-proBNP. PCT>1.81ng/ml was an independent predictor of repeated IVIG resistance in KD (OR 4.161, 95% CI 1.441~12.017, P=0.008). Conclusions: Our study illustrates the serum PCT level before initial IVIG treatment could be used to predict repeated IVIG resistance in KD.

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

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.

scholarly journals Plasma Clusterin Concentrations May Predict Resistance to Intravenous Immunoglobulin in Patients with Kawasaki Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mei-Chen Ou-Yang ◽  
Ho-Chang Kuo ◽  
I-Chun Lin ◽  
Jiunn-Ming Sheen ◽  
Fu-Chen Huang ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Ivig Infusion ◽  
Ivig Resistance ◽  
Before And After ◽  
The Difference ◽  
Reliable Marker

Kawasaki disease (KD) is an acute febrile vasculitic syndrome of early childhood often complicated by coronary artery lesion that drastically reduces the quality of life. The study aimed to identify a reliable marker for predicting nonresponsiveness to the first course of intravenous immunoglobulin (IVIG) in KD patients. A total of 63 patients with KD were enrolled in the study (IVIG response, 58; IVIG resistance, 5). Plasma samples were collected before and after IVIG infusion for measurement of biomarkers. Patients’ clinical characteristics and laboratory data were also analyzed. A receiver operating characteristic curve was generated to identify a cut-off value for predicting IVIG resistance. Among the biomarkers, the difference in plasma clusterin concentrations before and after IVIG infusion (CLUSTER 12) was significantly related to IVIG resistance (P=0.040; 95% confidence interval (CI): −25.8% to −6.0%). Using a CLUSTER 12 cut-off value of <8.52 mg/L, the odds ratio for IVIG resistance was 11.467 (95% CI: 1.186 to 110.853). Patients with plasma CLUSTER 12 concentrations >8.52 mg/L had a much higher risk of IVIG resistance than those with CLUSTER 12 concentrations <8.52 mg/L. Plasma clusterin concentration shows promise as a candidate biomarker for predicting IVIG resistance in patients with KD.

scholarly journals Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaheng Lu ◽  
Tingting Chen ◽  
Yizhou Wen ◽  
Feifei Si ◽  
Xindan Wu ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Ivig Treatment ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Ivig Resistance ◽  
Intravenous Immunoglobulin Resistance ◽  
Resistant Group

Abstract Background Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. Methods A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. Conclusions Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.

Kawasaki Disease: Early Presentation to the Otolaryngologist

1993 ◽  
Vol 108 (4) ◽  
pp. 344-347 ◽  
Author(s):  
Michael A. Seicshnaydre ◽  
Mary Ann Frable
Keyword(s):  
Kawasaki Disease ◽  
Early Diagnosis ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
Diagnosis And Treatment ◽  
Unknown Etiology ◽  
Cardiac Complications ◽  
Acute Febrile Illness ◽  
Conjunctival Injection ◽  
Early Presentation

Kawasaki disease is an acute febrile illness of unknown etiology that occurs primarily in childhood. Early diagnosis and treatment can reduce the risk of cardiac complications of Kawasaki disease, which carries a 1% to 2% mortality for cardiovascular events. Clinical features include: (1) fever (2) conjunctival injection (3) oral cavity changes (4) changes in the peripheral extremities (5) erythematous rash and (6) cervical adenopathy without suppuration. We describe three cases in detail and survey a series of 42 patients at our institution. Otolaryngologic manifestations were found to occur in the early stages of Kawasaki disease. The otolaryngologist may see these patients early in the disease and should be alert to the signs and symptoms for appropriate diagnosis and treatment. Characteristics of Kawasaki disease, difficulties in diagnosis during the initial febrile stage, and the importance of early diagnosis by the otolaryngologist is stressed.

scholarly journals 2021 Update on the Clinical Management and Diagnosis of Kawasaki Disease

2021 ◽  
Vol 23 (3) ◽  
Author(s):  
Frank Zhu ◽  
Jocelyn Y. Ang
Keyword(s):  
High Risk ◽  
Kawasaki Disease ◽  
Corticosteroid Therapy ◽  
Clinical Management ◽  
Treatment Guidelines ◽  
Day Treatment ◽  
Significant Proportion ◽  
Clinical Manifestations ◽  
Heart Association ◽  
Ivig Resistance

Abstract Purpose of Review Provide an updated review of the clinical management and diagnosis of Kawasaki disease with inclusion of potential diagnostic difficulties with multisystem inflammatory syndrome in children (MIS-C) given the ongoing COVID-19 pandemic. Recent Findings Adjunctive corticosteroid therapy has been shown to reduce the rate of coronary artery dilation in children at high risk for IVIG resistance in multiple Japanese clinical studies (most notably RAISE study group). Additional adjunctive therapies (etanercept, infliximab, cyclosporin) may also provide limited benefit, but data is limited to single studies and subgroups of patients with cardiac abnormalities. The efficacy of other agents (atorvastatin, doxycycline) is currently being investigated. MIS-C is a clinically distinct entity from KD with broad clinical manifestations and multiorgan involvement (cardiac, GI, hematologic, dermatologic, respiratory, renal). MIS-C with Kawasaki manifestations is more commonly seen in children < 5 years of age. Summary The 2017 American Heart Association (AHA) treatment guidelines have included changes in aspirin dosing (including both 80–100 mg/kg/day and 30–50 mg/kg/day treatment options), consideration of the use of adjuvant corticosteroid therapy in patients at high risk of IVIG resistance, and the change in steroid regimen for refractory KD to include both pulse-dose IVMP and longer course of prednisolone with an oral taper. A significant proportion of children diagnosed with MIS-C, a post-infectious syndrome of SARS-CoV-2 infection, meet criteria for Kawasaki disease. Further investigation is warranted to further delineate these conditions and optimize treatment of these conditions given the ongoing COVID-19 pandemic.

Abstract 132: Methylprednisolone Pulse Therapy for Kawasaki Disease with Symptomatic Myocarditis

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
yeo hyang kim ◽  
Chae Ok Shin ◽  
Myung Chul Hyun ◽  
Dong Seok Lee
Keyword(s):  
Kawasaki Disease ◽  
Systolic Function ◽  
Systemic Vasculitis ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
Pulse Therapy ◽  
Left Ventricular ◽  
Acute Stage ◽  
Z Score ◽  
Intravenous Methylprednisolone

Purpose: Kawasaki disease (KD) is an acute febrile illness of infants and young children that is characterized by a systemic vasculitis, especially involving the coronary arteries. Although, sometimes, subclinical myocarditis is combined in KD, symptomatic myocarditis is extremely uncommon. We report a 7 year old boy who developed hypotension and decreased left ventricular systolic function (EF 40%) in the acute phase of KD. Case: A 7 year old boy (height 115 cm, body weight 20 kg) was admitted because of 2 days of persistent fever and left cervical lymphadenopathy (white blood cell count 17,870 /mm 3 , C reactive protein 23.6 mg/dL). Conjunctiva injection and lip redness developed on the 4th day of illness, and hypotension and tachycardia (SBP 59/DBP 29 mmHg, HR 153/bpm) were combined. The echocardiography revealed a decreased ejection fraction (EF) (40%) without chamber dilatation and normal coronary artery size (LM 1.9mm, z score=-1.3, RCA 2.3mm, z score=0.4). The level of N terminal pro BNP was 28,000 pg/mL. With a diagnosis of KD with myocarditis, he was initially treated with inotropics and intravenous immunoglobulin (2 g/kg). Without clinical improvement in spite of initial treatment, A change of coronary arterial size (LM 2.9mm, z score=1.2, RCA 3.1mm, z score=2.3) was developed and decreased LV systolic function (EF 45%) and fever were persisted. Then, he was given 3 daily pulses of intravenous methylprednisolone followed by tapering doses of oral prednisolone. He showed prompt clinical recovery after pulse therapy of intravenous methylprednisolone (SBP 95/DBP 49 mmHg, HR 98/bpm). Although EF was improved (59%), coronary arterial dilatation was progressed (LM 3.4mm, z score=2.4 RCA 5.5mm, z score=7.9). Conclusions: The present case serves to highlight the fact that methylprednisolone should be considered as the priority in children with KD who have symptomatic myocarditis during the acute stage.

Lymphadenitis as the Dominant Manifestation of Kawasaki Disease

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 525-528
Author(s):  
Julie Kim Stamos ◽  
Kathleen Corydon ◽  
James Donaldson ◽  
Stanford T. Shulman
Keyword(s):  
Kawasaki Disease ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
The United States ◽  
Acute Febrile Illness ◽  
Conjunctival Injection ◽  
Coronary Abnormalities ◽  
Acquired Heart Disease ◽  
Mucosal Changes ◽  
Infants And Young Children

Kawasaki disease (KD) is an acute febrile illness primarily affecting infants and young children. Its importance relates to the fact that 20% to 25% of untreated patients develop coronary abnormalities that can lead to myocardial infarction or even to death.1 KD is a leading cause of acquired heart disease in children in many regions, including the United States.2 Because there are no specific diagnostic tests for KD, the diagnosis is established by the presence of fever and four of five criteria without other explanation for the illness: (1) nonexudative conjunctival injection; (2) oral mucosal changes; (3) changes of the peripheral extremities; (4) rash, primarily truncal; and (5) cervical lymphadenopathy.

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