Risk Factors of Coronary Artery Abnormalities and Resistance to Intravenous Immunoglobulin Plus Corticosteroid Therapy in Severe Kawasaki Disease: An Analysis of Post RAISE
| Autor: | Yukio Yamashita, Tsutomu Takahashi, Hiroyuki Yamagishi, Michiko Chiga, Toshimasa Obonai, Naoaki Hori, Hiroshi Sakakibara, Osamu Komiyama, Yoshihiko Morikawa, Tetsuji Kaneko, Masaru Miura, Takatoshi Tsuchihashi, Masahiro Misawa, Maki Nakazawa, Takahiro Matsushima, Koichi Miyata |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Adrenal cortex hormones 030204 cardiovascular system & hematology Mucocutaneous Lymph Node Syndrome Gastroenterology 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Risk Factors 030225 pediatrics Internal medicine medicine Humans In patient Prospective Studies Retrospective Studies biology business.industry Immunoglobulins Intravenous Infant medicine.disease Coronary Vessels medicine.anatomical_structure Corticosteroid therapy biology.protein Kawasaki disease Antibody Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Circulation. Cardiovascular quality and outcomes. 14(2) |
| ISSN: | 1941-7705 |
| Popis: | Background: Coronary artery abnormalities (CAAs) still occur in patients with Kawasaki disease receiving intensified treatment with corticosteroids. We aimed to determine the risk factors of CAA development and resistance to intensified treatment in Post RAISE (Prospective Observational Study on Stratified Treatment With Immunoglobulin Plus Steroid Efficacy for Kawasaki Disease)—the largest prospective cohort of Kawasaki disease patients to date. Methods: In Post RAISE, 2648 consecutive patients with Kawasaki disease were enrolled. The present study analyzed 724 patients predicted to be intravenous immunoglobulin (IVIG) nonresponders (Kobayashi score ≥5) who received intensified treatment consisting of IVIG plus prednisolone. The association between the baseline characteristics and CAA at 1 month after disease onset was examined. The association between the baseline characteristics and treatment resistance was also investigated. Results: Maximum Z score at baseline ≥2.5 (odds ratio, 3.4 [95% CI, 1.5–7.8]), age at fever onset Conclusions: In Post RAISE, younger age at fever onset, a larger maximum Z score at baseline, and nonresponsiveness to IVIG plus prednisolone were risk factors significantly associated with CAA development. Nonresponders were able to be identified at diagnosis based on the total bilirubin value. To prevent CAA, more intensified or adjunctive therapies using other agents, such as pulsed methylprednisolone, ciclosporin, infliximab, and Anakinra, should be considered for patients with these risk factors. Registration: URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000007133. |
| Databáze: | OpenAIRE |
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