Early treatment with intravenous immunoglobulin in patients with Kawasaki disease

Abstract

Objectives: To determine if a shorter interval between Kawasaki disease (KD) treatment with intravenous immunoglobulin (IVIG) and fever onset results in increased treatment failures, need for adjunctive therapy, or development of coronary artery lesions.

Study design: Patients with KD (n = 178; 89 matched pairs) diagnosed between 1987 and 1999 were included in this case-control study. All patients had fever plus at least 4 of the 5 clinical criteria for KD. Eighty-nine patients who received IVIG at day 5 or earlier were matched to patients diagnosed within 4 weeks and given IVIG at days 6 to 9 of fever. Compiled data from a detailed chart review included demographics, clinical features, fever duration, investigations, disease course, and response to therapy. Differences between matched case and control pairs were analyzed by means oft tests and McNemar tests.

Results: No demographic differences were noted between the two groups. Patients treated on day 5 or less of fever had a shorter total fever duration (5.2 +/- 1.9 days vs 8.0 +/- 1.8 days, P <.0001), longer fever after IVIG treatment (1.5 +/- 1.9 days vs 0.8 +/- 1.3 days, P =.008), and less coronary artery ectasia at 1 year after KD onset (4% vs 16%, P =.02). There was no significant difference between cases and control patients in the number of patients with KD recrudescence, need for repeat courses of IVIG, need for corticosteroids, length of hospitalization, or development of coronary artery aneurysms within the first 3 months. Patients who were treated on day 5 or less of fever had higher levels of serum albumin (36 +/- 5 g/L vs 33 +/- 5 g/L, P <.01) and serum ALT (115 +/- 155 U/L vs 46 +/- 49 U/L, P <.001) as well as a lower platelet count (354 +/- 131 vs 403 +/- 166, P =.02) than did control patients during the acute phase.

Conclusions: Early treatment of KD resulted in less coronary ectasia at 1 year after KD onset but was not associated with a quicker resolution of fever, an increased number of treatment failures, an increased need for adjunctive therapy, length of hospitalization, nor development of coronary artery lesions. In children with fever and classic clinical and laboratory findings of KD, treatment with IVIG on or before 5 days of fever resulted in better coronary outcomes and decreased the total length of time of clinical symptoms.