Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

Jiang Hui Cai; Mi Tang; Hong Xi Zhang; Er Dan Luo; Rui Zhang; Shu Ping Shuai; Hua Liang; Wan Jun Tao; Meng Jun Wu; Yang Wen; Yan Feng Yang

doi:10.1016/j.jped.2022.07.003

Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

J Pediatr (Rio J). 2023 Mar-Apr;99(2):161-167. doi: 10.1016/j.jped.2022.07.003. Epub 2022 Aug 20.

Authors

Jiang Hui Cai¹, Mi Tang², Hong Xi Zhang¹, Er Dan Luo³, Rui Zhang¹, Shu Ping Shuai¹, Hua Liang¹, Wan Jun Tao¹, Meng Jun Wu⁴, Yang Wen⁵, Yan Feng Yang⁶

Affiliations

¹ Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
² School of Medicine, University of Electronic Science and Technology of China; Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
³ Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁵ Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁶ Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. Electronic address: yangyanfengcwcc@126.com.

Abstract

Objective: To investigate the optimal timing of initial intravenous immunoglobulin (IVIG) treatment in Kawasaki disease (KD) patients.

Methods: KD patients were classified as the early group (day 1-4), conventional group (day 5-7), conventional group (day 8-10), and late group (after day 10). Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analyses and receiver operating characteristic (ROC) curve analysis.

Results: There were no significant differences in IVIG resistance among the 4 groups (p = 0.335). The sensitivity analysis also confirmed no difference in the IVIG resistance between those who started the initial IVIG ≤ day 7 of illness and those who received IVIG >day 7 of illness (p = 0.761). In addition, patients who received IVIG administration more than 7 days from the onset had a higher proportion of coronary artery abnormalities (p = 0.034) and longer length of hospitalization (p = 0.033) than those who started IVIG administration less than 7 days. The optimal cut-off value of initial IVIG administration time for predicting IVIG resistance was >7 days, with a sensitivity of 75.25% and specificity of 82.41%.

Conclusions: IVIG therapy within 7 days of illness is found to be more effective for reducing the risk of coronary artery abnormalities than those who received IVIG >day 7 of illness. IVIG treatment within the 7 days of illness seems to be the optimal therapeutic window of IVIG. However, further prospective studies with long-term follow-up are required.

Keywords: IVIG; IVIG resistance; Intravenous immunoglobulin; KD; Kawasaki disease.

MeSH terms

Humans
Immunoglobulins, Intravenous* / therapeutic use
Infant
Mucocutaneous Lymph Node Syndrome* / drug therapy
Prospective Studies
Retrospective Studies

Substances

Immunoglobulins, Intravenous