14 - RISK FACTORS FOR NON-RESPONSIVENESS TO SECOND COURSE OF INTRAVENOUS IMMUNOGLOBULIN MONOTHERAPY IN TAIWANESE CHILDREN WITH REFRACTORY KAWASAKI DISEASE: A MULTI-CENTER STUDY

Background

The standard rescue therapy for refractory Kawasaki disease (KD) typically involves a second course of monotherapy with intravenous immunoglobulin (IVIG). Nonetheless, certain patients fail to respond to this second IVIG monotherapy. This study aims to identify the risk factors associated with non-responsiveness to the second course of IVIG monotherapy by analyzing initial clinical parameters in Taiwanese children with refractory KD.

Methods

We conducted a retrospective review of 65 patients with refractory KD who underwent two courses of IVIG monotherapy across 13 hospitals in Taiwan between 2009 and 2021. The study compared patients who responded to the second IVIG monotherapy with those who were non-responsive. Comparative analyses were performed on clinical presentations, echocardiograms at the time of diagnosis, laboratory findings before the initial and second IVIG monotherapy.

Results

Among the 65 refractory KD patients studied, 50 individuals exhibited responsiveness to the second IVIG monotherapy, while 15 patients showed non-responsiveness. Statistically significant differences were observed in median fever duration (10 days in responsive group versus 16 days in non-responsive group, p< 0.0001), neutrophil percentage before the second IVIG (59.0% in responsive group versus 70.2% in non-responsive group, p=0.006), change in platelet count ratio before the second IVIG (53.5% in responsive group versus -6.5% in non-responsive group, p=0.024), and change in eosinophil count ratio before the second IVIG (30.4% in responsive group versus -60.0% in non-responsive group, p=0.002). Multi-variable logistic analysis identified a decrease in eosinophil count ratio of less than 30% as the sole significant risk factor for non-responsiveness to the second IVIG monotherapy (OR: 9.48, 95% CI: 1.28 to 70.15, p=0.028).

Conclusions

In patients with refractory KD, a reduction rate of 30% in the eosinophil count may serve as a risk factor, indicating a higher likelihood of non-responsiveness to the second IVIG monotherapy. Validation of this finding in an independent cohort is recommended for future research to further establish its clinical significance.