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Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients


Correspondence: Dr. Satoshi Sato, Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinju, Shinjuku, Tokyo 160-0023, Japan. Email:



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 (= 84) and an IVIG-resistant group (= 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.

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