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Elevated d ‐Dimer Level is a Risk Factor for Coronary Artery Lesions Accompanying Intravenous Immunoglobulin‐Unresponsive K awasaki Disease
Author(s) -
Masuzawa Yuko,
Mori Masaaki,
Hara Takuma,
Inaba Aya,
Oba Mari S,
Yokota Shumpei
Publication year - 2015
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12235
Subject(s) - medicine , fibrinogen , d dimer , kawasaki disease , gastroenterology , odds ratio , fibrin , coronary artery disease , antibody , artery , surgery , immunology
Abstract Although there are many reports on the resistance of K awasaki disease ( KD ) to initial intravenous immunoglobulin ( IVI g) therapy, risk factors for coronary artery lesions in such cases remain to be established. The objective of this study was to explore when additional therapies should be administered and to identify factors helpful for selecting a therapeutic option. Based on their written clinical records, we performed a retrospective review of KD patients who did not respond to initial IVI g therapy and who therefore then underwent plasma exchange ( PE ) therapy. This was a case‐control study to compare the presence or absence of acute coronary lesions in patients treated by PE for IVI g‐unresponsive KD at Y okohama C ity U niversity H ospital or at Y okohama C ity U niversity M edical C enter. Fifteen of 44 patients had acute coronary artery lesions ( CAL ) correlating with high levels of white blood cells ( WBC ) ( P = 0.045), d ‐dimer ( P = 0.008), and fibrin/fibrinogen degradation products ( P = 0.009) and lower levels of fibrinogen ( P = 0.013) prior to PE therapy. There was a strong correlation between pre‐ PE levels of albumin and d ‐dimer ( P earson's correlation coefficient of 0.610). Multivariate analyses revealed that the odds ratio for CAL when d ‐dimer was ≥ 4.5 μg/mL was 25.06 (95% CI , 2.56–244.91, P = 0.006). d ‐dimer elevation and albumin decline in IVI g‐unresponsive KD patients could be risk factors for acute CAL , suggesting the possibility that angitis has spread throughout the arterial system, as far as the coronary artery.