Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease

J Pediatr. 2006 Aug;149(2):237-40. doi: 10.1016/j.jpeds.2006.03.050.


Objectives: The objective of this study was to find the predictors and generate a prediction score of resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD).

Study design: Patients diagnosed as having KD were sampled when they received initial high-dose IVIG treatment (2 g/kg dose) within 9 days of illness (n = 320). These patients were divided into 2 groups: the resistance (n = 41) and the responder (n = 279). The following data were obtained and compared between resistance and responder: age, sex, illness days at initial treatment, and laboratory data.

Results: Multivariate logistic regression analysis identified age, illness days, platelet count, alanine aminotransferase (ALT), and C-reactive protein (CRP) as significant predictors for resistance to IVIG. We generated prediction score assigning 1 point for (1) infants less than 6 months old, (2) before 4 days of illness, (3) platelet count <or= 30 x 10(10)/L, (4) CRP >or= 8 mg/dL, as well as 2 points for (5) ALT >or= 80 IU/L. Using a cut-off point of 3 and more with this prediction score, we could identify the IVIG-resistant group with 78% sensitivity and 76% specificity.

Conclusions: Resistance to IVIG treatment can be predicted using age, illness days, platelet count, ALT, and CRP. Randomized, multicenter clinical trials are necessary to create a new strategy to treat these high-risk patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Alanine Transaminase / blood
  • Blood Platelets
  • Child
  • Child, Preschool
  • Drug Administration Schedule
  • Drug Resistance*
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Infant
  • Male
  • Mucocutaneous Lymph Node Syndrome / drug therapy*
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity


  • Immunoglobulins, Intravenous
  • Alanine Transaminase