46 - RISK FACTORS OF REFRACTORY KAWASAKI DISEASE IN LOW-RISK IVIG NONRESPONSE PREDICTION SCORE GROUP

Background:
Almost 20% of KD patients are refractory cases and fail to respond to initial IVIG. Multiple scoring systems for predicting IVIG non-responders have been proposed. The high-risk group patients are recommended to receive IVIG plus steroid therapy. Although some patients in low-risk group were IVIG non-responders, there were no predictive factors that have been identified the refractory KD in low-risk group. The aim of study is to assess the risk factors in patients with low risk of IVIG non-responders.
 

Methods:
A retrospective study was designed to evaluate the in children (younger than 15 years of age) with acute KD who were admitted Toho University Medical Center from January 2013 to December 2022. Patients were divided into initial IVIG responder group (RG) and non-responder group (NRG). NRG was defined as having a persistent or recurrent fever within 24 hours after initial IVIG. Coronary artery lesion (CAL) was defined as having a CA Z score of +2.5 SD or higher after 1 month of onset.

 

Results:
There were 608 patients diagnosed as acute KD, and 381 patients (63%) were low-risk group based on the Gunma score. The median age was 23 months with 221 boys and 160 girls. Of 381, 61 patients (16%) were non-responders in low-risk group. Although non-responders had higher serum sodium levels (135.2, 125-143 mEq/L vs 134.4, 125-140 mEq/L, p < 0.05) , C reactive protein, aspartate aminotransferase, platelet, albumin and brain natriuretic hormone levels were not significant difference between responders and non-responders. Among the major symptoms, the proportion of brawny edema was significantly higher in the non-responsive group than in the responsive group (81 patients (25%) vs 28 patients (46%), p=0.001). There were no differences between the two groups in terms of gender, the days of illness at initial treatment, the percent of incomplete KD, and pre-treatment Z score of CA.  


Conclusion:
Hyponatremia and Brawny edema is a potential risk factor for refractoriness to IVIG treatment in low-risk groups.