Griffin Joseph P, Powell Angela R, Bhagat Palak H, Bartlett Allison H, Rotolo Shannon M
Chicago State College of Pharmacy (JPG, ARP), Chicago, IL.
Department of Pharmacy (PHB, SMR), University of Chicago Comer Children's Hospital, Chicago, IL.
J Pediatr Pharmacol Ther. 2022;27(5):415-418. doi: 10.5863/1551-6776-27.5.415. Epub 2022 Jul 6.
Patients diagnosed with Kawasaki disease (KD) are at a high risk of developing coronary artery aneurysms. Intravenous immune globulin (IVIG) given in combination with aspirin is the standard of treatment for the prevention of coronary aneurysm. IVIG is recommended to be administered as a dose of 2 g/kg infused during 10 to 12 hours for the prevention of coronary aneurysms in KD; however, this does not always occur in practice. We aimed to investigate if an infusion time of <10 hours is associated with more coronary artery aneurysms than the recommended infusion time of 10 to 12 hours.
Patients with a diagnosis of and treated for KD with IVIG at the University of Chicago Medicine Comer Children's Hospital were identified by drug use reports that included patients who received IVIG between September 2008 and August 2018. Data were collected though chart review and patients were divided into 2 groups based on duration of infusion (<10 hours and 10-12 hours). The primary outcome was the incidence of coronary artery aneurysm. The secondary outcome was the time to defervescence. The safety outcome was the development of renal dysfunction.
A total of 70 patients were screened and 44 were included in the analysis. Coronary aneurysm occurred in 2 of 33 patients (6.0%) in the <10-hour group and no patients in the 10- to 12-hour group (p = 0.558). The median time to defervescence was 0.5 hours in the <10-hour group and 0.95 hours in the 10- to 12-hour group (p = 0.166). The incidence of acute kidney injury was 6% (2 of 33 patients) in the 10-hour group and 9.1% (1 of 11 patients) in the 10- to 12-hour group (p = 0.588).
All incidences of coronary artery aneurysm occurred in the patients who received IVIG with an infusion time of <10 hours. The incidence of acute kidney injury was numerically higher in the 10- to 12-hour group. Based on the recommendations in the American Heart Association KD guideline, our internal hospital policy, and our results, we recommend the infusion of IVIG be administered at a rate of 10 to 12 hours.
诊断为川崎病（KD）的患者发生冠状动脉瘤的风险很高。静脉注射免疫球蛋白（IVIG）联合阿司匹林是预防冠状动脉瘤的标准治疗方法。对于预防KD患者的冠状动脉瘤，建议以2 g/kg的剂量在10至12小时内输注IVIG；然而，在实际操作中并非总是如此。我们旨在研究输注时间<10小时是否比推荐的10至12小时输注时间导致更多的冠状动脉瘤。
通过药物使用报告确定在芝加哥大学医学科默儿童医院诊断为KD并接受IVIG治疗的患者，这些报告包括2008年9月至2018年8月期间接受IVIG的患者。通过病历审查收集数据，并根据输注持续时间（<10小时和10至12小时）将患者分为两组。主要结局是冠状动脉瘤的发生率。次要结局是退热时间。安全性结局是肾功能不全的发生情况。
共筛查了70例患者，44例纳入分析。<10小时组的33例患者中有2例（6.0%）发生冠状动脉瘤，10至12小时组无患者发生（p = 0.558）。<10小时组的中位退热时间为0.5小时，10至12小时组为0.95小时（p = 0.166）。<10小时组急性肾损伤的发生率为6%（33例患者中的2例），10至12小时组为9.1%（11例患者中的1例）（p = 0.588）。
所有冠状动脉瘤的发生均在输注时间<10小时的接受IVIG治疗的患者中。10至12小时组急性肾损伤的发生率在数值上更高。根据美国心脏协会KD指南、我们医院的内部政策以及我们的研究结果，我们建议以每10至12小时的速率输注IVIG。
