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首页> 外文期刊>Clinical drug investigation >Importance of C-reactive protein level in predicting non-response to additional intravenous immunoglobulin treatment in children with Kawasaki disease: a retrospective study.
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Importance of C-reactive protein level in predicting non-response to additional intravenous immunoglobulin treatment in children with Kawasaki disease: a retrospective study.

机译：C反应蛋白水平在预测川崎病患儿对其他静脉免疫球蛋白治疗无反应的重要性：一项回顾性研究。

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BACKGROUND: Intravenous immunoglobulin (IVIG) therapy in the acute stage of Kawasaki disease (KD; mucocutaneous lymph node syndrome) is the treatment of first choice for preventing the development of coronary artery lesions (CALs). Failure of initial treatment with IVIG remains the most consistent risk factor for CALs. However, there are few reports on nonresponders to additional IVIG therapy in KD. OBJECTIVE: The goal of the present study was to predict non-responders to additional IVIG therapy in children with KD. METHODS: This was a retrospective study aimed at predicting non-responders to additional IVIG therapy for KD in a cohort of 446 patients. The IVIG response group ('responders') was defined as those patients who were afebrile 48 hours after administration of initial IVIG. The IVIG non-response group ('non-responders') was defined as those patients who remained febrile 48 hours after administration of initial IVIG and was divided into two subgroups: (i) those patients who remained febrile 48 hours after administration of additional IVIG (non-responders 1), and (ii) those patients who were afebrile 48 hours after additional IVIG (non-responders 2). RESULTS: Ninety-one patients received additional IVIG; of these, 25 patients (non-responders 1) received additional rescue therapy because no improvement was observed and 66 patients (non-responders 2) were afebrile. Mean - SD C-reactive protein (CRP) levels were higher in non-responders 1 than in non-responders 2 (12.05 - 5.14 vs 7.67 - 4.99 mg/dL; p = 0.002). The optimal cutoff point of sensitivity and specificity for predicted non-responders was >/=8 mg/dL. The sensitivity and specificity for prediction of IVIG response was 76.0% and 63.6%, respectively. Forty-three patients had a CRP level of >/=8 mg/dL after initial IVIG, 18 of whom developed CALs (eight persistent lesions and ten transient lesions). Forty-eight patients had a CRP level of <8 mg/dL after initial IVIG, of whom only eight developed CALs (all transient). CONCLUSION: We have discovered a biomarker able to identify KD patients at high risk of complications who require additional IVIG treatment, thus avoiding overtreatment of low-risk individuals. We suggest that patients who have a CRP level of >/=8mg/dL after initial IVIG are likely to fail additional IVIG and may require further IVIG plus rescue therapy.
机译：背景：川崎病（KD;粘膜皮肤淋巴结综合征）急性期的静脉免疫球蛋白（IVIG）治疗是预防冠状动脉病变（CAL）发展的首选治疗方法。 IVIG初始治疗失败仍然是CAL的最一致危险因素。但是，很少有关于在KD中对额外IVIG治疗无反应的报道。目的：本研究的目的是预测KD患儿对额外的IVIG治疗无反应。方法：这是一项回顾性研究，旨在预测446例队列研究中对KD额外IVIG治疗无反应的患者。 IVIG反应组（“响应者”）定义为在初次IVIG给药后48小时出现发热的患者。 IVIG无反应组（“无反应者”）定义为初次使用IVIG后48小时仍保持发热的患者，并分为两个亚组：（i）再次使用IVIG后48小时仍保持发热的患者（无反应者1），以及（ii）再次IVIG后48小时出现发热的患者（无反应者2）。结果：91例患者接受了额外的IVIG治疗;其中，有25例患者（无反应者1）接受了额外的抢救治疗，因为未观察到改善，并且有66例患者（无反应者2）出现了发热。无反应者1的平均-SD C反应蛋白（CRP）水平高于无反应者2（12.05-5.14 vs 7.67-4.99 mg / dL; p = 0.002）。对于预测的无反应者，敏感性和特异性的最佳临界点为> / = 8 mg / dL。预测IVIG反应的敏感性和特异性分别为76.0％和63.6％。初次IVIG后有43例患者的CRP水平> / = 8 mg / dL，其中18例发展为CAL（8个持续性病变和10个短暂性病变）。初次IVIG后有48例患者的CRP水平<8 mg / dL，其中只有8例发展为CAL（均为短暂性）。结论：我们发现了一种生物标志物，能够鉴别出需要额外的IVIG治疗并发高危并发症的KD患者，从而避免了低危个体的过度治疗。我们建议初次IVIG后CRP水平> / = 8mg / dL的患者可能无法再接受额外的IVIG治疗，可能需要进一步的IVIG加抢救治疗。

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