Risk Factors for Coronary Artery Abnormalities in Patients with Kawasaki Disease Treated with Additional Intravenous Gamma-Globulin

Objective: Although an additional intravenous gamma-globulin (IVGG) treatment is commonly used for patients with Kawasaki disease (KD) who do not respond to the initial IVGG treatment, the efficacy of this strategy for preventing coronary artery abnormalities remains unclear. Our objective was to determine the risk factors associated with the development of coronary artery abnormalities in patients with KD treated with additional IVGG. Methods: We retrospectively assessed the risk factors for coronary artery abnormalities among 68 patients with KD treated with additional IVGG between 1993 and 1999 at 12 clinical centers in Japan. Results: According to univariate analyses, the risk factors for coronary artery abnormalities consisted of the duration of the initial IVGG treatment (>2 days), the duration of the fever before (>10 days) and after (>2 days) the start of the additional IVGG treatment, the white blood cell count (>15,000 /μl) and the C-reactive protein level (>5 mg/dl) before the additional IVGG treatment, and the use of steroid therapy. According to multivariate analyses, the risk factors for coronary artery abnormalities consisted of the duration of the fever before (>10 days; odds ratio, 8.51; 95 percent confidence interval, 2.13 to 33.9; P = 0.002) and after (>2 days; odds ratio, 4.66; 95 percent confidence interval, 1.25 to 17.3; P = 0.02) the start of the additional IVGG treatment. Conclusions: In patients with KD who do not respond to the initial IVGG treatment, the additional IVGG treatment within 10 days of the fever and resulting in the cessation of the fever within 2 days of administration reduce the risk for coronary artery abnormalities.