OBJECTIVE: The objective of this study was to evaluate the incidence and risk factors of children with refractory Kawasaki disease (KD).
METHODS: All children with KD were analyzed in Beijing from 2000 through 2004. Risk factors were analyzed by logistic regression. Refractory KD was defined as persistent fever of ≥38.5°C 36 hours after initial intravenous immunoglobulin (IVIg) treatment.
RESULTS: A total of 1052 patients (aged 1 month to 13.8 years) with IVIg treatment were included; of them, 135 did not respond to IVIg treatment, with an incidence of 12.8%. Refractory KD occurred more frequently in children who received 1 g/kg per day IVIg for 2 days (20.9%) than in those who received a single dose of 2 g/kg (9.9%) or 400 to 600 mg/kg per day for 4 days (8.7%). Logistic regression revealed that erythrocyte sedimentation rate, alanine aminotransferase, white blood cell count, serum albumin, time from onset to IVIg treatment, and IVIg dosage were independent risk factors for refractory KD. Children with refractory KD were re-treated: 8 received 2 g/kg IVIg, with 5 (62.5%) responding; 114 received 1 g/kg IVIg, with 35 (30.7%) responding; and 11 received 400 to 600 mg/kg IVIg, with (9.1%) responding. In addition, 2 received corticosteroids, with 2 responding.
CONCLUSIONS: The incidence of refractory KD in Beijing is 12.8%. A 2-g/kg dose of IVIg is probably the best re-treatment option for refractory KD.
Submitted by Zhong-Dong Du
- Copyright © 2008 by the American Academy of Pediatrics