Predictors of Intravenous Immunoglobulin Nonresponse and Racial Disparities in Kawasaki Disease
Predictors of Intravenous Immunoglobulin Nonresponse and Racial Disparities in Kawasaki Disease
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DOI：
10.1097/inf.0000000000002019
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发表时间：
2018-12-01
影响因子：
3.6
通讯作者：
Halasa, Natasha
中科院分区：
文献类型：
--
作者：
Clark, Daniel E.;Denby, Kara J.;Halasa, Natasha
背景：川崎病（KD）是美国儿童获得性心脏病最常见的原因。静脉注射免疫球蛋白（IVIG）无反应是已知的心脏后遗症的危险因素。既往报告的无应答风险因素包括年龄、男性和实验室检查异常。我们着手确定在种族多样的KD人群中IVIG无应答的其他危险因素。方法：我们在美国东南部的一个转诊中心对符合ICD-9的儿童进行了回顾性病历审查（国际疾病和相关健康问题统计分类）KD标准并接受IVIG治疗。结果：459名儿童符合入选标准，67名儿童因随后的风湿病诊断、未知种族或不符合美国心脏协会指南标准而被排除。我们的最终队列包括392例受试者，中位年龄为2.7岁，65.1%为男性，66.1%为白色，24.2%为黑人，4.9%为亚洲人，82.9%对单剂量IVIG有反应。冠状动脉扩张或动脉瘤占27%，动脉瘤占7.4%，巨大动脉瘤占2.3%。无应答者更可能是黑人，具有较高的白色血细胞、红细胞沉降率和C反应蛋白，较低的血红蛋白，发生扩张或动脉瘤，需要重症监护和再次入院。1年时，应答者实现超声心动图正常化的频率高于无应答者（81.3% vs. 60.9%，P = 0.002）和冠状动脉正常化（87.2% vs. 69.7%，P = 0.03）。黑人无应答者在1年时正常化最慢（52.9%，P = 0.02）。结论：无应答者比应答者有更高的冠状动脉受累率和更严重的冠状动脉受累程度。我们的研究独特地证明了黑人是1年随访时无反应和心脏受累延迟正常化的风险因素。
Background: Kawasaki disease (KD) is the most common cause of acquired heart disease in American children. Intravenous immunoglobulin (IVIG) nonresponse is a known risk factor for cardiac sequelae. Previously reported risk factors for nonresponse include age, male sex and laboratory abnormalities. We set out to identify additional risk factors for IVIG nonresponse in a racially diverse KD population.Methods: We conducted a retrospective chart review at a referral center in the Southeastern United States of children meeting ICD-9 (International Statistical Classification of Disease and Related Health Problems) criteria for KD and being treated with IVIG.Results: Four-hundred and fifty-nine children met inclusion criteria, 67 were excluded for subsequent rheumatologic diagnosis, unknown race, or failure to meet the American Heart Association guideline criteria. Our final cohort consisted of 392 subjects, with median age of 2.7 years, 65.1% male, 66.1% White, 24.2% Black, 4.9% Asian and 82.9% responded to a single dose of IVIG. Coronary ectasia or aneurysm developed in 27%; 7.4% developed aneurysms and 2.3% giant coronary aneurysms. Nonresponders were more likely to be Black, have higher white blood cell, erythrocyte sedimentation rate and C-reactive protein, lower hemoglobin, develop ectasia or aneurysm and require critical care and hospital readmission. Responders achieved echocardiographic normalization more often compared with nonresponders (81.3% vs. 60.9%, P = 0.002) and coronary artery pseudonormalization (87.2% vs. 69.7%, P = 0.03) at 1 year. Black nonresponders had the slowest normalization at 1 year (52.9%, P = 0.02).Conclusions: Nonresponders have higher rates and greater severity of coronary involvement than responders. Our study uniquely demonstrates Black race as a risk factor for nonresponse and for delayed normalization of cardiac involvement at 1-year follow-up.