Abstract
Although, the efficacy of 2g/kg IVGG has been widely accepted, 1g/kg single administration of IVGG(1g-IVGG) alone is also effective in a certain number of acute Kawasaki disease(KD) patients(pts). To investigate the efficacy of 1g-IVGG in acute KD pts, we reviewed 136 pts started with IVGG (108 pts started with 1g/kg, and 28 pts started with 2g/kg).
Among 108 pts, 1g-IVGG alone was effective in 68 pts(63%)(CRP: 7.7+/-3.7mg/dl), and 35(32%) of 40 pts(CRP:10.7+/-6.5mg/dl,p<0.05)) who required additional therapy(AT) such as IVGG, Predonisolone or Ulinastatin, responded well. 2g-IVGG was started in 28 pts(21%) and effective in 10 pts(7%). The other 18 pts(13%) required AT. Coronary arterial sequelaes were recognized in 5 pts(3.7%) in 1g-IVGG plus AT and 1 pts (0.7%) in 2g-IVGG plus AT. If initial CRP is <12 mg/dl and WBC <15,000/μl, 1g-IVGG alone seemed to be effective in 35/48(73%) of pts(CRP: 6.6 vs 11.7 mg/dl,p<0.05). WBC/neutrophil counts reduced by –34%/-60% and CRP by –36% after 48 hrs. In pts requiring 1g-IVGG plus AT, WBC/neutrophil decreased only by –7.3%/-34% and CRP by –34%.
We conclude that approximately 50%(68/136 pts) of acute KD pts can be treated with 1g-IVGG alone. CRP<12.0mg/dl and WBC<15,000μl seem to be good parameters that can predict the 73%response rate. Reduction of WBC/neutrophil and CRP may be hallmarks of the effectiveness.
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Matsuura, H., Saji, T., Sekiguchi, K. et al. Selection of Acute Kawasaki Disease Patients who can be Treated by 1g/kg Intravenous Gamma Globulin. Pediatr Res 53, 181 (2003). https://doi.org/10.1203/00006450-200301000-00165
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DOI: https://doi.org/10.1203/00006450-200301000-00165