Coronary risks after high-dose γ-globulin in children with Kawasaki disease

Objectives: The goals of the present study were to develop a predictive coronary risk scoring system after intravenous γ‐globulin (IVGG) therapy of any dose for the different preparations currently used in the treatment of children with Kawasaki disease and to determine the predictive value of the s...

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Published in:Pediatrics international 2000-10, Vol.42 (5), p.464-469
Main Authors: Morikawa, Yoshiyuki, Ohashi, Yasuo, Harada, Kensuke, Asai, Toshio, Okawa, Sumio, Nagashima, Masami, Katoh, Toshiyuki, Baba, Kunizo, Furusho, Kenshi, Okuni, Masahiko, Osano, Mitsuru
Format: Article
Language:English
Subjects:
Child
Coronary Disease - etiology
cross validation
Humans
Immunoglobulin G - blood
Immunoglobulins, Intravenous - administration & dosage
intravenous γ-globulin therapy
Kawasaki disease
Logistic Models
mucocutaneous lymph node syndrome
Mucocutaneous Lymph Node Syndrome - complications
Mucocutaneous Lymph Node Syndrome - drug therapy
Mucocutaneous Lymph Node Syndrome - immunology
Multivariate Analysis
Predictive Value of Tests
Risk Assessment
risk factor
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Summary:Objectives: The goals of the present study were to develop a predictive coronary risk scoring system after intravenous γ‐globulin (IVGG) therapy of any dose for the different preparations currently used in the treatment of children with Kawasaki disease and to determine the predictive value of the system. The previously reported scoring systems were based on treatment with high‐dose IVGG therapy at limited doses and were determined using investigative methods. Methods : Four hundred and fifty‐one patients were randomized into one of three groups and received either i.v. polyethylene glycol‐treated human immunoglobulin at a dose of either 200 (n=147) or 400 mg/kg per day (n=152) or freeze‐dried sulfonated human immunoglobulin at 200 mg/kg per day (n=152) for 5 consecutive days. We documented 31 cases of coronary abnormalities (CA). Univariate and multivariate logistic regression was performed using 49 clinical variables and the resulting predictive model was validated. Results : The duration of fever (odds (1 day)/odds (≥ 5 days)=0.158; 95% confidence interval (CI) 0.0385–0.648), hemoglobin (odds (Q1=10.3)/odds (Q3=11.6) = 3.97; 95% CI 1.92–8.20), IgG (odds (Q1=1900)/odds (Q3=2658)=2.72, 95% CI 1.18–6.25) and IgA (odds (Q1=72)/odds (Q3=160) =0.415; 95% CI 0.253–0.680) levels after completion of γ‐globulin infusion were independent predictors. The model is quasi‐cross validated and has acceptable sensitivity and selectivity. The estimated risk and observed occurence of CA coincide. Conclusions : Determinants of the risk of CA after IVGG therapy are a longer duration of fever, a lower IgG level, a higher IgA level and a lower hemoglobin level after IVGG infusion. This model is applicable for IVGG doses from 1 to 2 g/kg and for at least two different γ‐globulin preparations.
ISSN:1328-8067
1442-200X
DOI:10.1046/j.1442-200x.2000.01288.x