Risk Factors Evaluation Of Intravenous Immunoglobulin -Nonresponsive Kawasaki Diseas

Objective To evaluate the prevalence and risk factors of children with refractory Kawasaki disease(KD).Methods Clinical data of children with KD in Chongqing Children's Hospital were summarized from 2003 through 2009. Refractory KD was defined as remaining febrile with a temperature higher than 38oC, 48 hours after initial standardized intravenous immunoglobulin treatment (IVIG).Result A total of 1050 patients were included as study subjects. They received initial IVIG therapy within 10 days after disease onset, and there were 112 (10.67%, 112/1050) patients who did not respond to the initial IVIG therapy. Children with refractory KD had a higher prevalence of CAL at the acute phase (P<0.05). Logistic regression revealed that timing of IVIG treatment, duration of fever and total bilirubin were independent risk factors for refractory KD (P<0.05). Among the non-responders, twenty five (89.3%, 25/28) responded well to the second dose of IVIG (2g/kg), 3 out of 4 patients (75%, 3/4) responded well to 1g/kg×2d, whereas only 15 out of 33 patients (45.5%, 15/33) responded well to single dose of 1g/kg IVIG re-treatment (P<0.01). Conclusion The prevalence of refractory KD in this study is 10.67% (112/1050). Too early treatment of IVIG, duration of fever and total bilirubin level have been revealed independent risk factors for refractory KD. The second IVIG therapy with a single dose of 2g/kg appears to be more effective.