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. 2016 Dec;59(12):477-482.
doi: 10.3345/kjp.2016.59.12.477. Epub 2016 Dec 31.

Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease

Hye Young Lee  1 , Min Seob Song  2
Affiliations

Predictive factors of resistance to intravenous immunoglobulin and coronary artery lesions in Kawasaki disease

Hye Young Lee et al. Korean J Pediatr. 2016 Dec.

Abstract

Purpose: We conducted a study to determine which factors may be useful as predictive markers in identifying Kawasaki disease (KD) patients with a high risk of resistance to intravenous immunoglobulin (IVIG) and developing coronary artery lesions (CAL).

Methods: We enrolled 287 patients in acute phase of KD at a single center. The demographic, clinical and laboratory data were collected retrospectively.

Results: There were 34 patients in the IVIG resistant group. The IVIG resistant group had significantly higher serum N-terminal-pro-brain natriuretic protein (NT-proBNP) levels (P<0.01) and polymorphonuclear neutrophil (PMN) percentage (P<0.01) in comparison to the IVIG responders. The results yielded sensitivity (78.8%, 60.6%), specificity (58.2%, 90%) and cutoff value (628.6 pg/mL, 80.3%) of NT-proBNP and PMN respectively, in predicting IVIG resistance. Despite IVIG administration, 13 of the 287 patients developed CAL. The patients in the CAL group had higher NT-proBNP levels (P<0.01) and higher PMN percentage (P<0.01). In these patients, the results yielded sensitivity (73.3%, 56.7%), specificity (67.9%, 88.9%) and cutoff value (853.4 pg/mL, 80.3%) of NT-proBNP and PMN respectively, for predicting CAL. The area under the curve (AUC) for predicting resistance to IVIG was NT-proBNP 0.712, PMN 0.802. The AUC for predicting CAL was NT-proBNP 0.739, and PMN 0.773.

Conclusion: Serum NT-proBNP levels and PMN percentage were significantly elevated in patients with KD with IVIG resistance and CAL. Thus, they may be useful predicting markers for IVIG resistance and development of CAL in KD patients.

Keywords: Coronary artery; Immunoglobulin; Kawasaki disease; Neutrophils; Pro-brain natriuretic protein.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Receiver-operating characteristic curves comparing the sensitivity and specificity of various variables (resistance to intravenous immunoglobulin treatment). PMN, polymorphonuclear neutrophil percentage; ALT, alanine aminotransferase; CRP, C-reactive protein; NT-proBNP, N-terminal-pro-brain natriuretic protein.
Fig. 2
Fig. 2. Receiver-operating characteristic curves comparing the sensitivity and specificity of various variables (prediction of coronary artery lesion). PMN, polymorphonuclear neutrophil percentage; ALT, alanine aminotransferase; CRP, C-reactive protein; NT-proBNP, N-terminal-pro-brain natriuretic protein.
Fig. 3
Fig. 3. Correlation between elevated N-terminal-pro-brain natriuretic protein (NT-proBNP) levels and C-reactive protein (CRP).
See this image and copyright information in PMC

References

    1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16:178–222. - PubMed
    1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747–2771. - PubMed
    1. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition) Pediatr Int. 2005;47:232–234. - PubMed
    1. Giannouli G, Tzoumaka-Bakoula C, Kopsidas I, Papadogeorgou P, Chrousos GP, Michos A. Epidemiology and risk factors for coronary artery abnormalities in children with complete and incomplete Kawasaki disease during a 10-year period. Pediatr Cardiol. 2013;34:1476–1481. - PubMed
    1. Nasser N, Bar-Oz B, Nir A. Natriuretic peptides and heart disease in infants and children. J Pediatr. 2005;147:248–253. - PubMed

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