Abstract O.43: Partial and Complete Non-response to Intravenous Immunoglobulin in the Acute Treatment of Kawasaki Disease: A Matched Case-control Study
Introduction: Patients non-responsive to intravenous immunoglobulin (IVIG) in the acute phase of Kawasaki disease (KD) are usually considered a single patient group; however, response to second-line therapy varies significantly. We sought to characterize the pattern of temperature response to IVIG infusion, and to define whether the profile was associated with response to second-line therapy in non-responders.
Methods: Patients non-responsive to IVIG (temperature >37.5°C >24 hours after the end of IVIG) were identified. Each IVIG non-responder was matched to a IVIG-responsive control patient of the same age and gender, and with the same duration of fever prior to IVIG. Hourly temperature profiles were obtained from immediately before the start of the IVIG infusion until complete defervescence.
Results: n=202 patients non-responsive to IVIG were matched (total n=404). For all, temperature reduced by 0.17 (0.06)°C per g/hr IVIG (p=0.006). Important variation in the temperature profile was noted for patients who did not defervesce with IVIG. Thus, non-responders were further classified as partial non-responders (31%) (temperature decreased to <37.5°C within 24 hours of the end of IVG infusion, but fever recurred) and complete non-responders (69%) (temperature consistently >37.5°C throughout IVIG treatment). The temperature profile during IVIG infusion was similar between complete and partial responders [(EST: -0.26 (0.11)°C per g/hr IVIG (p=0.02) for complete responders vs. EST: -0.20 (0.09)°C (p=0.02) for IVIG responders (responders vs. partial non-responders, p=0.65)]. In complete non-responders, IVIG was not associated with significant decreases in temperature (EST: -0.11 (0.14)°C, p=0.43). Factors associated with complete (vs. partial) non-response included presence of infectious symptoms, differences in multiple laboratory values and IVIG brand. Defervescence in partial non-responders was achieved with a second IVIG dose for 88% of patients compared to only 47% of complete non-responder (p<0.001).
Conclusions: Non-response to initial IVIG can be further characterized by the temperature profile, and complete non-responders may require more aggressive second-line therapy.
Author Disclosures: M.L. Downie: None. C. Manlhiot: None. G.A. Latino: None. T.H. Collins: None. N. Chahal: None. R.S. Yeung: None. B.W. McCrindle: None.
- © 2015 by American Heart Association, Inc.