Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset

Children with Kawasaki disease (n = 82), treated with intravenous immune gl obulin (IVIG) at a high dose, were classified as IVIG-responsive (defervesc ence within 5 days of starting IVIG, n = 69) or IVIG-non-responsive (consis tent fever over a 6-day period since starting IVIG, n = 13). One patient in the IVIG-responsive group had a coronary artery abnormality during the acu te phase (1.4%) versus 5 in the IVIG-non-responsive group (38.5%). Age, dur ation of fever before the initiation of IVIG therapy: and laboratory data o btained on admission were tested by the Mann-Whitney U test. Serum levels o f C-reactive protein, total bilirubin, lactate dehydrogenase and gamma-glut amyltranspeptidase were significantly higher (P = .002, P < .001, P < .034, and P < .038, respectively), and the hemoglobin value was significantly lo wer (P = .025) in patients in the non-responsive group. A multivariate anal ysis showed that serum levels of C-reactive protein (P = .006), lactate deh ydrogenase (P = .035), and total bilirubin (P = .046) on admission were ind ependent correlates of the success of IVIG therapy. By defining the predict ive values, patients with a C-reactive protein level >10 mg/dL, LDH level > 590 IU/L, and/or hemoglobin value <10 g/dL are considered non-responsive to IVIG. Additional therapy at an early stage of the disease should be consid ered for patients who are predicted to be IVIG-non-responsive.