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A 2-year-old Japanese boy presented with a 3-day history of fever. He was lethargic and tachycardic, which made clinicians suspect sepsis. He was hospitalised for antibiotic treatment. On day 5, he developed bilateral conjunctivitis and erythematous lips. His cervical lymph nodes were enlarged, and erythema multiforme-like rashes were observed on the trunk. He was diagnosed with Kawasaki disease (KD), and intravenous immunoglobulin (IVIG) therapy was administered. He required two courses of IVIG as he did not respond to the initial treatment. He eventually developed coronary artery aneurysms (CAAs).
On blood tests taken at his admission, procalcitonin was measured to evaluate sepsis. We questioned whether it was possible to predict his IVIG resistance or CAA development with procalcitonin so that initial treatment could have been intensified.
Structured clinical question
In children with KD (patient), do patients with high pretreatment procalcitonin levels (intervention) have a higher risk of IVIG resistance or CAA formation (outcome) compared with those with low pretreatment procalcitonin level (comparison)?
We performed a literature search via MEDLINE, EMBASE and Cochrane Library by using the keywords “Kawasaki disease”, “IVIG resistance”, “coronary artery aneurysms” and “procalcitonin”. All searches were performed on 27 February 2023. Articles that searched the association between pretreatment procalcitonin levels and IVIG resistance or CAA development in patients with KD were included. Articles written in a language other than English and unavailable in the full text were excluded. The search identified 42 articles, and 8 relevant articles were selected for further review. The results of the …
Contributors KI drafted the initial manuscript. HH, MB, CG and JAH critically revised the manuscript. All authors approved the final version as submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CG was funded by the UK Medical Research Council (MRC) through a Clinician Scientist Fellowship award; received support from Chiesi Pharmaceuticals to attend an educational conference; in the past 36 months, he was an investigator who received research grants from MRC, National Institute of Health Research, Canadian Institute of Health Research, Action Medical Research and Chiesi Pharmaceuticals. The other authors declared no competing interests.
Provenance and peer review Not commissioned; internally peer reviewed.