Risk factors for nonresponse to therapy in Kawasaki disease

Abstract

Objective: To study the refractory cases of Kawasaki disease (KD) and identify potential risk factors in patients in whom standard therapy fails.

Study design: A retrospective chart review of patients with KD admitted from January 1, 2002, through December 31, 2006. Demographic, clinical, laboratory, echocardiographic, and therapeutic data were recorded.

Results: Of 196 patients, 40 (20%) needed re-treatment. The number of refractory cases were 7 (14.3%), 6 (17.1%), 11(28.9%), 10 (24.4%), and 6 (17.6%) for 2002 to 2006, respectively. There were no significant differences in age, sex, ethnicity, number of days with symptoms at diagnosis, white blood cell count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). Refractory patients had higher band counts (22.7% vs 7%), lower albumin levels (3 vs 3.4), and a higher number of abnormal echocardiography results at diagnosis (80% vs 16.1%).

Conclusions: An elevated band count, low albumin level, and an abnormal initial echocardiography result can be useful tools to identify patients at risk for a more complicated clinical course.