Clinical Study On Risk Factors Analysis Of Intravenous Immune Globulin Resistance In Children With Kawasaki Disease According To The Different Duration Of Fever Before Treatment

Objective:By analyzing the differences of clinical data of children with Kawasaki disease(KD)with different fever duration before treatment,to explore the corresponding risk factors of intravenous immune globulin(IVIG)resistance in children with KD with different fever duration,in order to better identify IVIG resistant cases and provide reference for clinicians’diagnosis.Methods:The case data of children with KD treated in the Qingdao Women and Children’s Hospital admitted from January 2018 to December 2021 were retrospectively collected,and were divided into short fever duration group(fever duration≤4 days)and long fever duration group(fever duration>4 days)according to the duration of fever before IVIG treatment,and each group was subdivided into drug-resistant group and non-drug-resistant group according to the occurrence of IVIG resistance,and the general information,clinical characteristics and laboratory results of these groups were analyzed.The risk factors of IVIG resistance in different fever duration were analyzed using multivariable logistic stepwise regression.Results:1.A total of 650 cases of children with KD were included,including 181 cases in the short fever duration group and 469 cases in the long fever duration group;48 cases of IVIG resistance in the short fever duration group,accounting for 26.5%,15 cases of coronary artery aneurysm(CAA)in the group,accounting for 8.3%;61 cases of IVIG resistance in the long fever duration group,accounting for 13.0%,37 cases of CAA in the group,accounting for 7.9%.The rate of IVIG resistance was higher in the short fever duration group than in the long fever duration group(P<0.05),whereas the incidence of CAA was not significantly different between the two groups(P>0.05).2.Comparison of clinical data in in different fever duration:In the short fever duration group,the pre-treatment sodium of drug-resistant children was lower than that of non-drug-resistant children,while rash incidence,CAA incidence,alanine aminotransferase,procalcitonin(PCT),C-reactive protein(CRP)and N-terminal B-type natriuretic peptide were higher than those of without drug resistant(P<0.05);In the long fever duration group,the pre-treatment sodium and creatine kinase were lower in drug-resistant children than in non-drug-resistant children,while rash incidence and CRP were higher than those of non-drug-resistant children(P<0.05).3.Multivariate logistic stepwise regression analysis showed that the increase of PCT was an independent risk factor for IVIG resistance in the short fever duration group(P<0.05).When PCT≥0.945 ng/m L,the efficiency of predicting whether children with fever duration≤4 days before IVIG treatment have IVIG resistance is the greatest.The decrease of Na~+was an independent risk factor of IVIG resistance in the long fever duration group(P<0.05).When Na~+≤134.5 mmol/L,the efficiency of predicting whether children with fever duration>4 days before IVIG treatment have IVIG resistance is the greatest.Conclusions:Research findings,risk factors for IVIG resistance in children with KD varied with the duration of fever before treatment.PCT≥0.945 ng/m L and Na~+≤134.5mmol/L are independent risk factors of IVIG resistance in the short fever duration group and long fever duration group,respectively.The results of this study will help to better identify IVIG resistance in children with KD,and is of great significance to improve the therapeutic effect and prognosis of children.