Risk Factors Evaluation Of Intravenous High-dose Immunoglobulin Non-responsive Kawasaki Disease

Objective To investigate the incidence,risk factors and the outcomeof retreat-ment of children with refractory Kawasaki disease(KD).Methods Clinical data of KD patients hospitalized from August2011through August2012were retrospectively reviewed. All KD patients weredivided into two groups, responsive group and non-responsive group,according to their response to the first high dose IVIG therapy.Result A total of544patients were involved.They received initialIVIG therapy within10days after disease onset, and there were54(9.93%,54/544) patients who did not respond to the IVIGtherapy.490(90.07%,490/544) patients responded to the IVIG therapy;There were not statistical differences between the two groups in prevalenceof CAL at the acute phase (P>0.05). Patients of non-responsiveness grouphad longer duration of fever,lower percentage of lymphocyte,lessHyperemia bulbar,more sinus tachycardia and first degreeauriculoventricular block than those of responsivenessgroup(P<0.05).Logistic regression revealed that duration of fever was independent risk factor for refractory KD (P<0.05).Among thenon-responders, twenty five (89.2%,25/28) responded well to the seconddose of IVIG (2g/kg),Steroid was used in2children with bothresponding,infliximab was used in1children among thosenon-responders.Almost half of the the non-responders can defervesce at thethird or forth day after the initial IVIG therapy,.these patients had shortduration of fever,hospital stay,more light anemia degree,lower levels ofPlatelet than those of receive the second dose of IVIG(P<0.05),and therewere no statistical differences in prevalence of CAL between the group ofonly having first IVIG and the group of receiving second dose of IVIG(P>0.05) in non-responders.Conclusion The prevalence of refractory KD in this study is9.93%(54/544). duration of fever is the independent risk factor for refractory KD.Retreated of children with refractory KD with a2g/Kg IVIG is probablymore effective. For those who remain febrile after two doses of IVIG canpulse Steroid. those refractory KD patients who can defervesce at the third orforth day after the initial IVIG therapy have no obvious influence inCoronary lesions recovery in the late stage.clinical observation of duratin offever after initial IVIG therapy can be appropriatelyextended.Electrocardiogram has a great significance in the early evaluationcardiac involvement of kawasaki disease.