Characteristics of Patients with Kawasaki Disease Who Showed Non-Responsiveness to Initial Intravenous Immunoglobulin Treatment Who Were Predicted as Being at Low Risk of Being a Non-Responder

Abstract

Background: Patients with Kawasaki disease（KD）who show non-responsiveness to initial intravenous immunoglobulin treatmen（t IVIG）are at high risk of coronary artery abnormalit（y CAA）. Kobayashi et al. reported a useful prediction score for determining non-responders to the initial IVIG（Kobayashi score）; however, some patients are non-responders despite having low scores. We investigated the characteristics of these non-responders.
Methods: Clinical findings of nine non-responders and 114 responders with low Kobayashi scores（4 points or fewer）were compared.
Results: The incidence of non-responders who were 6 months old or younger was significantly higher than responders（44% vs. 12%; p =0.026）. Although both groups of patients were admitted at the same illness day, non-responders showed a significantly higher incidence of two or fewer principal KD symptoms at admission compared with responders（56% vs. 15%; p =0.009）.
Conclusions: Even in patients with low Kobayashi scores, those who are 6 months old or younger are potential non-responders. Those who have two or fewer principal KD symptoms at admission and show a rapid increase in the number of symptoms are also potential non-responders. Careful observation for symptoms of non-responsiveness after initial IVIG is required for these patients.