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Predicting IVIG resistance in UK Kawasaki disease
  1. Sarah Davies1,
  2. Natalina Sutton1,
  3. Sarah Blackstock1,
  4. Stuart Gormley1,2,
  5. Clive J Hoggart3,
  6. Michael Levin1,2,
  7. Jethro A Herberg1,2
  1. 1Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Section of Paediatrics, Imperial College London, London, UK
  3. 3Department of Genomics of Common Disease, Imperial College London, London, UK
  1. Correspondence to Dr Jethro A Herberg, Section of Paediatrics, Imperial College, Norfolk Place, London W2 1PG, UK; j.herberg{at}imperial.ac.uk

Abstract

The Kobayashi score (KS) predicts intravenous immunoglobulin (IVIG) resistance in Japanese children with Kawasaki disease (KD) and has been used to select patients for early corticosteroid treatment. We tested the ability of the KS to predict IVIG resistance and coronary artery abnormalities (CAA) in 78 children treated for KD in our UK centre. 19/59 children were IVIG non-responsive. This was not predicted by a high KS (11/19 IVIG non-responders, compared with 26/40 responders, had a score ≥4; p=0.77). CAA were not predicted by KS (12/20 children with CAA vs 25/39 with normal echo had a score ≥4; p=0.78). Low albumin and haemoglobin, and high C-reactive protein were significantly associated with CAA. The KS does not predict IVIG resistance or CAA in our population. This highlights the need for biomarkers to identify children at increased risk of CAA, and to select patients for anti-inflammatory treatment in addition to IVIG.

  • Kawasaki Disease
  • Kobayashi Score
  • IVIG-resistant
  • prediction

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