Risk Factors Of Intravenous Immunoglobulin Resistance And Coronary Artery Lesions In Kawasaki Disease

Background and purpose:Kawasaki disease(KD)is an acute febrile disease of unknown cause,which usually occurs in children under 5 years of age.The systemic vasculitis of Kawasaki disease primarily affects small and medium-sized arteries,especially coronary artery.In developed countries,Kawasaki disease has become the most common cause of acquired heart disease.Patients with untreated or IVIG resistance have higher risk for coronary artery lesions.There are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of disease by now.The purpose of our research was to assess the risk factors of Intravenous Immunoglobulin Resistance and Coronary Artery Lesions in Kawasaki Disease.Materials and methods:We conducted a retrospective review of medical records for 300 KD patients,at Children's Hospital,Zhejiang University School of Medicine,from April 2015 to July 2016.Patients were divided into 2 groups:intravenous immunoglobulin responsive group and resistant group.According to echocardiographic examination,the patients were divided into two groups:CALs group and NCALs group.Clinical and biological variables were compared between two groups.Receiver operating characteristic curves(ROC)were applied to determine the optimal cutoff values of laboratory findings.The variables were included in a multivariate logistic regression model.All statistical analyses were performed using SPSS software version 20.0 Values were considered significantly different at p<0.05.Results:The intravenous immunoglobulin resistant group had significantly higher d-dimer,globulin and serum ferritin levels in comparison to the intravenous immunoglobulin responders.D-dimer level had a sensitivity of 87.0%and a specificity of 56.3%for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L.Globulin had a sensitivity of 62.1%and a specificity of 82.3%for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/1.Serum ferritin level had a sensitivity of 42.9%and a specificity of 88.8%for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/ml.The patients with coronary artery lesions had higher d-dimer and tumor necrosis factor-a level.D-dimer level had a sensitivity of 50%and a specificity of 78.6%for predicting coronary artery lesions at a cutoff point of 1.84 mg/L.Based on analysis by multivariate logistic regression,serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance,d-dimer was independent risk for coronary artery lesions.Conclusions:1.Elevated serum ferritin,globulin,D-dimer Levels and lower albumin,Hemoglobin,A/G were risk factors for IVIG resistance in patients with Kawasaki disease.2.Male,elevated D-dimer,TNF-a and lower albumin,Hemoglobin and Platelet count after IVIG treatment were were risk factors for coronary artery lesions.3.Serum D-dimer was independent risk factors for coronary artery lesions;the optimal D-dimer cut-off value for predicting coronary artery lesions was 1.84mg/1.