PMID- 29570178
OWN - NLM
STAT- MEDLINE
DCOM- 20190624
LR  - 20211204
IS  - 1532-0987 (Electronic)
IS  - 0891-3668 (Linking)
VI  - 37
IP  - 12
DP  - 2018 Dec
TI  - Predictors of Intravenous Immunoglobulin Nonresponse and Racial Disparities in 
      Kawasaki Disease.
PG  - 1227-1234
LID - 10.1097/INF.0000000000002019 [doi]
AB  - 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.
FAU - Clark, Daniel E
AU  - Clark DE
AD  - From the Departments of Internal Medicine and Pediatrics, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
FAU - Denby, Kara J
AU  - Denby KJ
AD  - From the Departments of Internal Medicine and Pediatrics, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
FAU - Kaufman, Laura M
AU  - Kaufman LM
AD  - Greater Lawrence Family Health Center, Lawrence, Massachusetts.
FAU - Fill, Mary-Margaret A
AU  - Fill MA
AD  - Tennessee Department of Health.
FAU - Piya, Bhinnata
AU  - Piya B
AD  - Division of Pediatric Infectious Disease, Department of Pediatrics, Vanderbilt 
      University Medical Center.
FAU - Krishnaswami, Shanthi
AU  - Krishnaswami S
AD  - Division of Pediatric Infectious Disease, Department of Pediatrics, Vanderbilt 
      University Medical Center.
FAU - Fonnesbeck, Christopher
AU  - Fonnesbeck C
AD  - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
FAU - Halasa, Natasha
AU  - Halasa N
AD  - Division of Pediatric Infectious Disease, Department of Pediatrics, Vanderbilt 
      University Medical Center.
LA  - eng
GR  - UL1 TR000445/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Pediatr Infect Dis J
JT  - The Pediatric infectious disease journal
JID - 8701858
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
CIN - Pediatr Infect Dis J. 2018 Nov;37(11):e279-e280. PMID: 30308604
MH  - Child, Preschool
MH  - Echocardiography
MH  - Ethnicity
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Infant
MH  - Male
MH  - Mucocutaneous Lymph Node Syndrome/*drug therapy/ethnology
MH  - Race Factors
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - United States
EDAT- 2018/03/24 06:00
MHDA- 2019/06/25 06:00
CRDT- 2018/03/24 06:00
PHST- 2018/03/24 06:00 [pubmed]
PHST- 2019/06/25 06:00 [medline]
PHST- 2018/03/24 06:00 [entrez]
AID - 10.1097/INF.0000000000002019 [doi]
PST - ppublish
SO  - Pediatr Infect Dis J. 2018 Dec;37(12):1227-1234. doi: 
      10.1097/INF.0000000000002019.