Fever pattern and C-reactive protein predict response to rescue therapy in Kawasaki disease
Fever pattern and C-reactive protein predict response to rescue therapy in Kawasaki disease
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DOI：
10.1111/ped.12762
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发表时间：
2016-03-01
影响因子：
1.4
通讯作者：
Oka, Akira
中科院分区：
文献类型：
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作者：
Nakagama, Yu;Inuzuka, Ryo;Oka, Akira
背景：缺乏指导难治性川崎病（KD）抢救治疗的证据。本研究的目的是确定预测难治性KD患者对抢救治疗无反应的最重要变量。方法回顾性分析171例首次静脉注射免疫球蛋白（IVIG）耐药的难治性KD患者。参与者接受由IVIG单药或IVIG加强的松龙组成的抢救治疗。对抢救治疗无应答者和应答者的特征和实验室变量进行比较。采用多因素logistic回归分析确定对抢救治疗无反应的独立预测因素。结果171例患者中，54例（31.6%）对抢救治疗无反应。在单因素分析中，首次IVIG后的发热模式、抢救治疗时的发病天数、抢救治疗方案和6个实验室变量（IVIG前钠、c反应蛋白[CRP]； IVIG后白细胞计数、血小板计数、钠、CRP）可用于区分无反应者和反应者。将这9个变量纳入多元逻辑回归分析。首次IVIG后持续发热（aOR, 2.39; 95%CI: 1.07-5.37）和IVIG后CRP （aOR, 1.09; 95%CI: 1.02-1.17，每增加1mg/dL）被确定为对抢救治疗无反应的独立预测因素。IVIG抢救单药治疗（aOR, 3.05; 95%CI: 1.05-8.84）在调整发热模式和IVIG后CRP后也预测无应答。结论首次IVIG后持续发热和CRP升高可预测难治性KD患者对抢救治疗无反应。对于无反应风险高的患者，IVIG加强的松龙，甚至进一步强化的抢救治疗方案可能更可取。
BackgroundEvidence to guide rescue therapy in refractory Kawasaki disease (KD) is lacking. The aim of this study was to determine the most important variables in predicting non-response to rescue therapy in refractory KD.MethodsWe retrospectively analyzed 171 patients diagnosed with refractory KD resistant to initial i.v. immunoglobulin (IVIG). Participants received rescue therapy consisting of IVIG monotherapy or IVIG plus prednisolone. Characteristics and laboratory variables were compared between rescue therapy non-responders and responders. Multivariate logistic regression analysis was performed to determine the independent predictors of non-response to rescue therapy.ResultsAmong the 171 participants, 54 (31.6%) were non-responders to rescue therapy. On univariate analysis, fever pattern after initial IVIG, day of illness at rescue therapy, rescue therapy regimen and six laboratory variables (pre-IVIG sodium, C-reactive protein [CRP]; post-IVIG white blood cell count, platelet count, sodium, CRP) were useful in discriminating between non-responders and responders. These nine variables were included in multivariate logistic regression analysis. Persistent fever after initial IVIG (aOR, 2.39; 95%CI: 1.07-5.37) and post-IVIG CRP (aOR, 1.09; 95%CI: 1.02-1.17, per 1mg/dL increase) were identified as independent predictors of non-response to rescue therapy. IVIG rescue monotherapy (aOR, 3.05; 95%CI: 1.05-8.84) also predicted non-response after adjusting for fever pattern and post-IVIG CRP.ConclusionsPersistent fever and elevated CRP after initial IVIG are predictive of non-response to rescue therapy for refractory KD. For patients at high risk of non-response, IVIG plus prednisolone, or even further intensified rescue therapy regimens may be preferable.