Background Factors Associated with the Complications of Coronary Artery Lesions Caused by Kawasaki Disease
Clinical Medicine Research
Volume 4, Issue 5, September 2015, Pages: 127-131
Received: Jul. 1, 2015;
Accepted: Jul. 23, 2015;
Published: Aug. 1, 2015
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Toshimasa Nakada, Department of Pediatrics, Aomori Prefectural Central Hospital, Aomori City, Japan
Appropriate therapy during the acute phase of Kawasaki disease to prevent large coronary artery lesions (CAL) has not been established. The aim of this retrospective study was to investigate the usefulness of an initial single intravenous immunoglobulin (IVIG) therapy. In this study, I included a total of 200 pediatric patients who had received 2g/kg/day IVIG therapy for Kawasaki disease between 1999 and 2015 at the Department of Pediatrics, Aomori Prefectural Central Hospital. An initial IVIG therapy starting on day 5 was used as first-line therapy when possible. The second-line therapy was additional IVIG therapy, and the third-line therapy was an urinastatin infusion or plasma exchange. All patients received an initial single IVIG therapy with delayed or with concomitant administration of aspirin or flurbiprofen. Initial IVIG therapy resistance occurred in 48 of 200 patients (24%), and 17 patients (9%) received additional IVIG therapy. Four patients received urinastatin and one patient received plasma exchange as the third-line therapy. Before the 30th day, the prevalence of CAL was 5% (10/200); after 30 days, it was 2% (4/200). The maximal internal CAL diameter was 4.8 mm (Z score = 6.3) among all patients. Variable factors including IVIG resistance, responsiveness, and relapse of disease were associated with CAL complications. An initial single IVIG therapy may be useful for the prevention of large CAL caused by different factors of Kawasaki disease.
Background Factors Associated with the Complications of Coronary Artery Lesions Caused by Kawasaki Disease, Clinical Medicine Research.
Vol. 4, No. 5,
2015, pp. 127-131.
Burns JC, Glodé MP. Kawasaki syndrome. Lancet 2004; 364:533–544.
Muller F, Knirsch W, Harpes P, Prêtre R, Valsangiacomo BE, Kretschmar O. Long-term follow-up of acute changes in coronary artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions. Clin Res Cardiol 2009; 98:501–507.
Tsuda E, Kamiya T, Ono Y, Kimura K, Kurosaki K, Echigo S. Incidence of stenotic lesions predicted by acute phase changes in coronary arterial diameter during Kawasaki disease. Pediatr Cardiol 2005; 26:73–79.
Nakada T. Prevention of large coronary artery lesions caused by Kawasaki disease. Medical Research Archives 2015. DOI: http://dx.doi.org/10.18103/mra.v0i3.138
Furusho K, Kamiya T, Nakano H, et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet 1984; 2: 1055–1058.
Newburger JW, Takahashi M, Beiser AS, et al. Single intravenous infusion of gamma globulin as compared with four infusion in the treatment of acute Kawasaki syndrome. N Engl J Med 1991; 324:1633–1639.
Research committee of the Japanese Scociety of Pediatric Cardiology; Cardiac Surgery committee for development of guidelines for medical treatment of acute Kawasaki disease. Guidelines for medical treatment of acute Kawasaki disease: report of the Research committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version). Pediatr Int 2014; 56:135-158.
Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomized, open-label, blinded-endpoints trial. Lancet 2012; 379:1613–1620.
Tremoulet AH, Jain S, Jaggi P, et al. Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet 2014; 383:1731–1738.
Uehara R, Belay ED, Maddox RA, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 2008; 27:155–160.
Nakada T. Effects of anti-inflammatory drugs on intravenous immunoglobulin therapy in the acute phase of Kawasaki disease. Pediatr Cardiol 2015; 36:335–339.
Nakada T. Study on the patients with Kawasaki disease associated with coronary artery lesions before therapy. Japanese Journal of Pediatrics 2015; 68:1410–1414.
Nakamura Y, Yanagawa H, Ojima T, Kawasaki T, Kato H. Cardiac sequelae of Kawasaki disease among recurrent cases. Arch Dis Child 1998; 78:163–165.
Yang H, Du ZD, Fu P. Clinical features of recurrent Kawasaki disease and its risk factors. Eur J Pediatr 2013; 172:1641–1647.
The Japan Kawasaki disease research committee. Diagnostic guidelines of Kawasaki disease. 5th revised ed, Tokyo, 2002.
Research committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Ministry of Health and Welfare, Tokyo, 1994.
Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 2006; 149:237-240.
Sleeper LA, Minich LL, McCrindle BM, et al. Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance. J Pediatr 2011; 158:831-835.
Davies S, Sutton N, Blackstock S, et al. Predicting IVIG resistance in UK Kawasaki disease. Arch Dis Child 2015; 100:366-368.
Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006; 113:2606-2612.
Ashida A, Ozaki N, Kishi K, Katayama H, Okasora K, Tamai H. A case report of refractory Kawasaki disease with bilateral giant coronary aneurysms treated with intravenous immunoglobulin and prednisolone combination therapy. Progress in Medicine 2013; 33:1471-1474.
Zorzi AD, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998; 133:254–258.