Risk Stratification in the Decision to Include Prednisolone With Intravenous Immunoglobulin in Primary Therapy of Kawasaki Disease

• DOI: 10.1097/inf.0b013e3181950b64
• Publication Date: 2009-05-29T07:19:32Z
• Authors: Tohru Kobayashi; Yoshinari Inoue; Tetsuya Otani; Akihiro Morikawa; Tomio Kobayashi; Kazuo Takeuchi; Tsutomu Saji; Tomoyoshi Sonobe; Shunichi Ogawa; Masaru Miura; Hirokazu Arakawa
• Keywords: Male; Analysis of Variance; Prednisolone; Immunoglobulins, Intravenous; Infant; Coronary Artery Disease; Mucocutaneous Lymph Node Syndrome; Statistics, Nonparametric; 3. Good health; 03 medical and health sciences; Logistic Models; Treatment Outcome; 0302 clinical medicine; Risk Factors; Child, Preschool; Humans; Female; Retrospective Studies

We reported previously that intravenous immunoglobulin (IVIG) plus prednisolone for initial therapy for Kawasaki disease (KD) prevented coronary artery abnormalities (CAA) more effectively than IVIG alone. However, questions remain as to whether PSL has potential benefit in all KD patients. The present study was designed to explore the possibility of stratified initial therapy including PSL in patients with and without a high predicted risk of being an IVIG nonresponder.We retrospectively analyzed data from KD patients who received IVIG (n = 896) or IVIG + PSL (n = 110) by scoring the likely risk of being an IVIG nonresponder. We compared clinical and coronary outcomes between treatment-defined groups separately for high- and low-risk patients.Among low-risk patients (score 0-4), clinical and coronary outcomes were similar. Among high-risk patients (score 5 or more), incidences of treatment failure and coronary artery abnormalities until 1-month follow-up were more frequent in the IVIG than in the IVIG + PSL group. Sex- and score point-adjusted odds ratios for IVIG + PSL were 0.17 (95% confidence interval, 0.08-0.39) for treatment failure and 0.27 (95% confidence interval, 0.07-0.85) for coronary artery abnormalities A among high-risk patients.IVIG + PSL treatment was associated with improving clinical and coronary outcomes in patients at high risk of being IVIG nonresponders.