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Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients
Author(s) -
Sato Satoshi,
Kawashima Hisashi,
Kashiwagi Yasuyo,
Hoshika Akinori
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12082
Subject(s) - kawasaki disease , medicine , immunology , antibody , intravenous immunoglobulin therapy , disease , immunoglobulin g , artery
Objectives Kawasaki disease ( KD ) is an acute systemic vasculitis. Activation of the immune system is a central feature of KD . Some KD patients are resistant to initial high‐dose intravenous immunoglobulin ( IVIG ) treatment. The study aimed to determine the predictors of IVIG resistance. Method A single‐center, retrospective study was conducted using data from 129 patients diagnosed with KD . Two groups of patients emerged within the IVIG ‐treated population (105 patients): an IVIG responder group ( n = 84) and an IVIG ‐resistant group ( n = 21). Laboratory data and patient characteristics were compared between the two groups. Results The average serum interleukin (IL)‐6 level was 102.7 ± 97.4 pg/mL in the IVIG responder group and 207.7 ± 127.1 pg/mL in the IVIG resistant group ( P < 0.01). C‐reactive protein (CRP) levels and neutrophil percentages were significantly elevated in the IVIG resistant group. Multivariate logistic regression analysis identified that a prediction score could be generated by assigning two points to neutrophil percentages ≥ 75%, and either two points for an IL‐6 level ≥ 140 pg/mL or one point for an IL‐6 level ≥ 70 pg/mL but < 140 pg/mL. A cut‐off score of ≥ three allowed identification of IVIG‐resistant patients with an 85% sensitivity and 77% specificity. Conclusions Resistance to IVIG therapy is characterized by elevated levels of IL ‐6, CRP and percentages of circulating neutrophils. Resistance to IVIG treatment can be predicted using a scoring system involving IL ‐6 and percentages of neutrophils.