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Description

Fukunishi et al identified laboratory findings associated with resistance to high-dose intravenous gamma globulin (IVIG) in a child with Kawasaki disease. These can help identify a child who may benefit from closer monitoring and more aggressive management. The authors are from Suita Municipal Hospital in Osaka, Japan.


 

IVIG responders had fever defervescence within 5 days of starting high-dose IVIG therapy. If fever persisted to the sixth day or longer, then the person was considered a non-responder. About 13% of children will be nonresponders.

 

IVIG doses ranged from 300 mg/kg for 4-5 days to 400 mg/kg for 3-5 days.

 

Parameters:

(1) serum levels of C-reactive protein (CRP)

(2) serum lactate dehydrogenase (LDH)

(3) hemoglobin

 

A person was considered a non-responder if one or more of the following was present on admission to the hospital:

(1) CRP > 10 mg/dL

(2) serum LDH > 590 IU/L

(3) hemoglobin < 11 g/dL

 

A person who was a non-responder:

(1) is at higher risk for coronary artery aneurysms

(2) should receive additional anti-inflammatory therapy at an early stage of disease

 

Performance:

• The sensitivity was 85% and specificity 86% for identifying nonresponders.

 

Limitations:

• The normal reference range and method for LDH were not specified. A value of 590 IU/L was considered to be significantly higher than normal.

 


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