Smelser Lauryn, Vejzovic Jennifer, Johnson Emma, Schultz Jordan, Wood Kelly E
Department of Pharmaceutical Care (LS, JV), University of Iowa Stead Family Children's Hospital, Iowa City, IA.
College of Pharmacy (EJ), University of Iowa, Iowa City, IA.
J Pediatr Pharmacol Ther. 2022;27(2):141-146. doi: 10.5863/1551-6776-27.2.141. Epub 2022 Feb 9.
Kawasaki disease (KD) is an acute febrile childhood vasculitis with a predilection for the coronary arteries treated with IVIG. In the United States, scoring systems to identify children at high-risk of persistent fever after initial IVIG treatment are lacking. Our study attempts to identify variables associated with IVIG non-response.
Retrospective review of patients ages 0 to 18 admitted to an US academic children's hospital between August 1, 2010, and August 31, 2019, with the diagnosis of acute KD who received IVIG during hospitalization.
A total of 64 patients were included, 73% male and 66% Caucasian with a mean age of 3.67 ± 3.35 years. Forty-eight patients (75%) received 1 dose of IVIG, and 16 (25%) received 2 doses of IVIG. The groups did not differ significantly at baseline. None had coronary artery aneurysms detected during hospitalization. Older age, female sex, Caucasian compared with African American race, leukocytosis, and hyponatremia were associated with a higher likelihood of IVIG non-response but none reached statistical significance. Patients who received ibuprofen (n = 26) were more likely to be IVIG non-responsive (p < 0.05). Aspirin dosing varied but was not predictive of IVIG non-response.
In this study, risk factors to predict IVIG non-response in patients treated for KD were not identified. IVIG non-response was significantly more common in those receiving ibuprofen during the acute treatment phase. Larger studies are needed to validate the association of ibuprofen administration and IVIG non-response in patients with KD.
川崎病（KD）是一种急性发热性儿童血管炎，易累及冠状动脉，通常采用静脉注射免疫球蛋白（IVIG）治疗。在美国，缺乏用于识别初次IVIG治疗后持续发热高危儿童的评分系统。我们的研究旨在确定与IVIG无反应相关的变量。
回顾性分析2010年8月1日至2019年8月31日期间在美国一家学术儿童医院住院的0至18岁急性KD诊断患者，这些患者在住院期间接受了IVIG治疗。
共纳入64例患者，男性占73%，白种人占66%，平均年龄为3.67±3.35岁。48例患者（75%）接受了1剂IVIG，16例（25%）接受了2剂IVIG。两组在基线时无显著差异。住院期间均未检测到冠状动脉瘤。年龄较大、女性、白种人与非裔美国人相比、白细胞增多和低钠血症与IVIG无反应的可能性较高相关，但均未达到统计学意义。接受布洛芬治疗的患者（n = 26）更有可能对IVIG无反应（p < 0.05）。阿司匹林剂量各不相同，但不能预测IVIG无反应。
在本研究中，未确定KD治疗患者中预测IVIG无反应的危险因素。在急性治疗阶段接受布洛芬治疗的患者中，IVIG无反应明显更为常见。需要更大规模的研究来验证布洛芬给药与KD患者IVIG无反应之间的关联。
