scholarly journals Prediction of Resistant to Intravenous Immunoglobulin (IVIG) Treatment in Patients with Kawasaki Disease in the Tertiary Care Hospital.

2021 ◽  
Author(s):  
Sarinrath Charoonrochana ◽  
Kittipol Klaiklueng ◽  
Rattawanlop Somanundana
Keyword(s):  
Kawasaki Disease ◽  
Serum Albumin ◽  
Predictive Factors ◽  
Serum Sodium ◽  
Scoring System ◽  
Study Patient ◽  
Ivig Treatment ◽  
P Value ◽  
Close Monitoring ◽  
Resistant Group

Abstract Background: Kawasaki disease (KD)is an acute autoimmune systemic vasculitis disease that mainly occurs in infancy and younger children. It has the potential to cause coronary artery lesions (CALs) develop in up to 20-25% of patients with untreated KD caused morbidity and mortality in children worldwide especially in Asia. Objective: To determine the predictive factors of IVIG resistant Kawasaki disease in Thailand Method: A retrospective descriptive study. Patient charts of all patients who had newly diagnosed of KD in Bhumibol Adulyadej Hospital, Thailand between January 2010 and December 2020 were reviewed. The protocol was approved by the ethic review committee. Results: A total of 102 subjects met the inclusion criteria and were enrolled into the study, including 17 cases of IVIG resistant (17/97, 28.5%) and 80 cases of IVIG responder (80/97, 71.4%).Demographic and laboratory characteristics were obtained. Male gender has greater in number in IVIG resistant group. Average age is 27 months and IVIG resistant tends to have age below 6 months old. Two variables were significantly lower in IVIG-resistant group than IVIG-responder group, including serum albumin (3.01±0.51vs 3.48±0.49 g/dL, p-value = 0 . 01) and serum sodium (133.24±3.43 vs 135.79±3.19 mEq/L, p-value = 0.01) meanwhile age at time of diagnosis less than 6 months (29.4% vs 8.75%, p-value = 0.02) and serum ALT (78.29±74.19 versus 71.01±80.19 IU/L, p-value = 0.02) were significantly higher in IVIG-resistant group than IVIG-responder group. Conclusion: The predictive factors of our study by univariate analysis included age below 6 months, serum albumin <3.5g/dL, serum sodium <135mmol / L and high serum ALT≥45 IU/L. The principal findings in our predictive model is the scoring system for predicting IVIG-resistant patients in Thai population, the scoring system includes total peripheral WBC count >18,000 mm 3 . (1 point), serum albumin < 3.5 g/dl (1 point) and serum ALT ≥ 45 IU/L (1.5 points), and a total score equal 2 points and higher yielded a sensitivity and a specificity of 82.35% and 62.50%, respectively for IVIG resistance prediction, who require more close monitoring which may help physicians make more rational decisions regarding an initial treatment of KD and be the candidates for additional therapies. Our study is similar to previous studies in Japan, a risk scoring system prior to administrate IVIG.

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.

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 Long-Term Hypermethylation of FcγR2B in Leukocytes of Patients with Kawasaki Disease

2021 ◽  
Vol 10 (11) ◽  
pp. 2347
Author(s):  
Ling-Sai Chang ◽  
Hong-Ren Yu ◽  
Chiao-Lun Chu ◽  
Kuang-Den Chen ◽  
Ying-Hsien Huang ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Dynamic Change ◽  
Disease Onset ◽  
Ivig Treatment ◽  
Gamma Receptor ◽  
Activating Receptors ◽  
Resistant Group ◽  
One Year ◽  
Whole Blood Cells

The Fc gamma receptor family contains several activating receptors and the only inhibitory receptor, FcγR2B. In this study, we investigated the dynamic methylation change of FcγR2B in different stages of Kawasaki disease (KD). We enrolled a total of 116 participants, which included patients with febrile diseases as controls and KD patients. Whole blood cells of KD patients were collected prior to intravenous immunoglobulin (IVIG) treatment (KD1), three to seven days after IVIG (KD2), three weeks after IVIG treatment (KD3), six months after IVIG (KD4), and one year after IVIG treatment (KD5). In total, 76 KD patients provided samples in every stage. Leukocytes of controls were also recruited. We performed DNA extraction and pyrosequencing. FcγR2B methylation levels were higher in KD3 compared to both the controls and KD1. A significantly higher methylation of FcγR2B was found in KD5 when compared with KD1. FcγR2B methylation levels in the IVIG-resistant group were lower than those in the IVIG-responsive group at KD1-3 (p = 0.004, 0.004, 0.005 respectively). This study is the first to report the dynamic change of FcγR2B methylation and to demonstrate long-term hypermethylation one year after disease onset. Hypomethylation of FcγR2B is associated with IVIG resistance.

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.

Tight junction protein ZO-1 in Kawasaki disease

2020 ◽  
Author(s):  
Wan-Tz Lai ◽  
Ying-Hsien Huang ◽  
Mao-Hung Lo ◽  
Ho-Chang Kuo
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Tight Junction ◽  
Statistical Significance ◽  
Intestinal Barrier ◽  
Ivig Treatment ◽  
P Value ◽  
Coronary Artery Lesions ◽  
Barrier Dysfunction ◽  
Intestinal Barrier Dysfunction

Abstract BackgroundKawasaki disease (KD) is a form of systemic febrile vasculitis that can be complicated by coronary artery lesions (CAL). A murine model of KD vasculitis showed that the vasculitis depended on intestinal barrier dysfunction, as well as that the tight junctions maintain the intestinal barrier. In this study, we aimed to investigate the role of tight junction Zonula occludens-1 (Zo-1) in intravenous immunoglobulin (IVIG) treatment response and the occurrence of CAL formation in KD patients.MethodsForty KD patients, 12 healthy controls, and 12 febrile controls were enrolled in this study. Tight junction ZO-1 levels were measured in sera by enzyme-linked immunosorbent assay.ResultsThe serum Zo-1 level was higher in the fever control group but did not achieve statistical significance. Patients who received a second dose of IVIG due to a failure to respond to the initial IVIG treatment had a higher serum tight junction Zo-1 level, but also without statistical significance (p value =0.0582). Patients who developed a coronary artery lesion had a lower serum tight junction Zo-1 level with statistical significance (p value =0.0275).ConclusionsTight junction ZO-1 levels decrease in KD patients with coronary artery lesions and are associated with the intestinal barrier dysfunction of Kawasaki disease and the occurrence of CAL in KD patients.

scholarly journals Desquamation in Kawasaki Disease

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 317
Author(s):  
Ling-Sai Chang ◽  
Ken-Pen Weng ◽  
Jia-Huei Yan ◽  
Wan-Shan Lo ◽  
Mindy Ming-Huey Guo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Laboratory Data ◽  
Ivig Treatment ◽  
Low Grade ◽  
High Grade ◽  
Laboratory Findings ◽  
Coronary Artery Abnormalities ◽  
Cell Counts ◽  
Hands And Feet

(1) Background: Desquamation is a common characteristic of Kawasaki disease (KD). In this study, we analyzed patients’ varying desquamation levels in their hands or feet, in correlation with clinical presentation, to assess the relationship. (2) Methods: We retrospectively reviewed children with KD. We analyzed their age, laboratory data before intravenous immunoglobulin (IVIG) treatment and coronary artery abnormalities (CAA) based on the desquamation level of their hands and feet. We classified the desquamation level from 0 to 3 and defined high-grade desquamation as grade 2 and 3. (3) Results: We enrolled a total 112 patients in the study. We found the hands’ high-grade desquamation was positively associated with age and segmented neutrophil percentage (p = 0.047 and 0.029, respectively) but negatively associated with lymphocyte and monocyte percentage (p = 0.03 and 0.006, respectively). Meanwhile, the feet’s high-grade desquamation was positively associated with total white blood cell counts (p = 0.033). Furthermore, we found that high-grade hand desquamation had less probability of CAA formation compared with that of a low grade (7.1% vs. 40.8%, p = 0.016). (4) Conclusions: This report is the first to demonstrate that the desquamation level of hands or feet in KD is associated with different coronary artery abnormalities and laboratory findings.

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 Serum sodium in relation to various domains of cognitive function in the elderly US population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sohyae Lee ◽  
Jin-young Min ◽  
Beom Kim ◽  
Sang-Won Ha ◽  
Jeohng Ho Han ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Function ◽  
Serum Sodium ◽  
Verbal Memory ◽  
The Elderly ◽  
Cognitive Change ◽  
Cognitive Test ◽  
P Value ◽  
Digit Symbol Substitution Test ◽  
Cross Sectional

Abstract Background Recent evidence suggests that sodium imbalances may be associated with cognitive impairment; however, the association between specific domains of cognition remains unclear. This study examines the association between serum sodium levels and immediate and delayed verbal memory as measured by the CERAD Word Learning Test (CERAD WLT), executive function as measured by the Animal Fluency test (AFT), and sustained attention, working memory, and processing speed as measured by the Digit Symbol Substitution test (DSST) in the elderly population of the US aged 60 and older who participated in the 2011–2014 National Health and Nutrition Examination Surveys (n = 2,541). Methods Cognitive function tests were performed by trained interviewers and sodium levels were measured using indirect ion selective electrode methodology. Results After adjusting for all covariates, quintiles of CERAD WLT scores showed significant positive associations with log-transformed sodium levels (Immediate recall (IR) β = 4.25 (SE = 1.83, p-value 0.027); Delayed recall (DR) β = 6.54 (SE = 1.82, p-value 0.001)). Compared to normal sodium levels, hyponatremia was significantly associated with lower CERAD WLT-IR (β = -0.34, SE = 0.15, p-value 0.035) and CERAD WLT-DR scores (β -0.48, SE = 0.10, p-value < 0.001) and showed borderline significance with AFT scores (β = = -0.38, SE = 0.19, p-value 0.052). Hypernatremia did not show any significant relationships with cognitive test scores, compared to normal sodium levels. Conclusions Our cross-sectional study showed that lower sodium levels were associated with cognitive change, especially regarding memory and executive function.

Prediction of Recurrence in Patients with Stage III Colon Cancer Using Conventional Clinicopathological Factors and Peripheral Blood Test Data: A New Analysis with Artificial Intelligence

Oncology ◽  
2021 ◽  
Vol 99 (5) ◽  
pp. 318-326
Author(s):  
Yutaro Kamei ◽  
Tetsuro Takayama ◽  
Toshiyuki Suzuki ◽  
Kenichi Furihata ◽  
Megumi Otsuki ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Colon Cancer ◽  
Serum Albumin ◽  
Test Data ◽  
Predictive Factors ◽  
Blood Test ◽  
Stage Iii ◽  
Clinicopathological Factors ◽  
Stage Iii Colon Cancer ◽  
Staging Systems

Background: Survival rate may be predicted by tumor-node-metastasis staging systems in colon cancer. In clinical practice, about 20 to 30 clinicopathological factors and blood test data have been used. Various predictive factors for recurrence have been advocated; however, the interactions are complex and remain to be established. We used artificial intelligence (AI) to examine predictive factors related to recurrence. Methods: The study group comprised 217 patients who underwent curative surgery for stage III colon cancer. Using a self-organizing map (SOM), an AI-based method, patients with only 23 clinicopathological factors, patients with 23 clinicopathological factors and 34 of preoperative blood test data (pre-data), and those with 23 clinicopathological factors and 31 of postoperative blood test data (post-data) were classified into several clusters with various rates of recurrence. Results: When only clinicopathological factors were used, the percentage of T4b disease, the percentage of N2 disease, and the number of metastatic lymph nodes were significantly higher in a cluster with a higher rate of recurrence. When clinicopathological factors and pre-data were used, three described pathological factors and the serum C-reactive protein (CRP) levels were significantly higher and the serum total protein (TP) levels, serum albumin levels, and the percentage of lymphocytes were significantly lower in a cluster with a higher rate of recurrence. When clinicopathological factors and post-data were used, three described pathological factors, serum CRP levels, and serum carcinoembryonic antigen levels were significantly higher and serum TP levels, serum albumin levels, and the percentage of lymphocytes were significantly lower in a cluster with a higher rate of recurrence. Conclusions: This AI-based analysis extracted several risk factors for recurrence from more than 50 pathological and blood test factors before and after surgery separately. This analysis may predict the risk of recurrence of a new patient by confirming which clusters this patient belongs to.

A COMPARATIVE STUDY OF ABG PATTERN IN PATIENTS OF COPD WITH OR WITHOUT COR PULMONALE

2021 ◽  
pp. 64-66
Author(s):  
Md Shoeb Alam ◽  
Rahul Ranjan ◽  
V N Jha
Keyword(s):  
Hypoxic Pulmonary Vasoconstriction ◽  
Respiratory Acidosis ◽  
Public Health Problem ◽  
Cor Pulmonale ◽  
Chronic Obstructive ◽  
P Value ◽  
Major Public Health Problem ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major public health problem. COR PULMONALE describes the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or increased pulmonary artery pressure. Hypoxic pulmonary vasoconstriction, hypercapnia, respiratory acidosis and pulmonary vascular remodeling in COPD can cause an increase in right ventricular (RV) after load, which in turn, results in RVfailure leading to COR PULMONALE AIM:The purpose of the study is to compare the ABG pattern in patients of COPD with or without COR PULMONALE. MATERIALS AND METHODS: This prospective observational study was conducted in the Department of Medicine of DMCH, Laheriasarai, Bihar. The study was conducted with duration of 2 years. Atotal of 100 patients admitted as a case of COPD with or without COR PULMONALE. The patients were put into two subgroups, COPD with and without COR PULMONALE. RESULT: The mean duration was 10.17 years and 9.20 years respectively in patients with and without COR PULMONALE. There was no statistically signicant difference regarding mean duration of disease (p value =0.304). Mean CAT score was 16.59 ± 6.26 and mean mMRC was 3.19± 0.45 in COPD patients with COR PULMONALE group. Mean CAT score was 14.06 ± 4.46 and mean mMRC was 3.10 ± 0.44 in COPD patients without COR PULMONALE group. We found no signicant difference among these variables between groups. Although COR PULMONALE patients had higher CATscore and mMRC score, the difference was not signicant (p value = >0.05). CONCLUSION:ABG ANALYSIS should be recommended for all patients of COPD with or without COR PULMONALE to assess the degree of hypoxemia, hypercapnea, respiratory acidosis and also, we can identify individuals who need more close monitoring and intensive treatment.

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