Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients
Version of Record online: 18 JUN 2013
© 2013 The Authors International Journal of Rheumatic Diseases © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
International Journal of Rheumatic Diseases
Volume 16, Issue 2, pages 168–172, April 2013
How to Cite
Sato, S., Kawashima, H., Kashiwagi, Y. and Hoshika, A. (2013), Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients. International Journal of Rheumatic Diseases, 16: 168–172. doi: 10.1111/1756-185X.12082
- Issue online: 18 JUN 2013
- Version of Record online: 18 JUN 2013
- CRP ;
- IVIG ;
- Kawasaki disease;
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.
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.
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.
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.