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Liu J, Chen X, Yang M, Shen F, Zhu F, Jin J, Teng Y. C-reactive protein to albumin ratio as a prognostic tool for predicting intravenous immunoglobulin resistance in children with kawasaki disease: a systematic review of cohort studies. Pediatr Rheumatol Online J 2024; 22:42. [PMID: 38610057 PMCID: PMC11010335 DOI: 10.1186/s12969-024-00980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) is the primary treatment for Kawasaki disease (KD). However, 10-20% of KD patients show no response to IVIG treatment, making the early prediction of IVIG resistance a key focus of KD research. Our aim is to explore the application of the C-reactive protein to albumin ratio (CAR) for predicting IVIG resistance in children with KD through meta-analysis. METHODS Cochrane Library, PubMed, MEDLINE, EMbase, CNKI, WanFang, the Chinese Biomedical Database, and CQVIP were searched up to November 2023 for cohort studies on predicting IVIG-resistant KD using the CAR. Articles were selected based on pre-established inclusion and exclusion criteria after extracting literature data and assessing them using the QUADAS-2.0 tool for evaluating the accuracy of diagnostic tests. Stata 15.0 software was used for meta-analysis. RESULTS Four Chinese and English literature reports were included in this meta-analysis. The results revealed the presence of a threshold effect and high heterogeneity among the included studies. The combined sensitivity for CAR predicting IVIG-resistant KD was calculated as 0.65 (95% CI 0.58-0.72), specificity as 0.71 (95% CI 0.57-0.81), and the area under the curve (AUC) as 0.70 (95% CI 0.66-0.74) using the random-effects model. The combined positive likelihood ratio was 2.22 (95% CI 1.35-3.65), the combined negative likelihood ratio was 0.49 (95% CI 0.35-0.69), and the diagnostic odds ratio was 5 (95% CI 2-10). CONCLUSION CAR is an auxiliary predictive indicator with moderate diagnostic value that provides guidance in the early treatment of the disease, demonstrating a certain predictive value that warrants further investigation. However, CAR cannot yet be considered as a definitive diagnostic or exclusionary marker for IVIG-resistant KD. Therefore, multi-center, large sample, and high-quality long-term follow-up trials are warranted to confirm the current findings.
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Affiliation(s)
- Jue Liu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Xingguang Chen
- Department of orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Minling Yang
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Fangfang Shen
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Feng Zhu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Jian Jin
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
| | - Yiqun Teng
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
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Friedman KG, McCrindle BW, Runeckles K, Dahdah N, Harahsheh AS, Khoury M, Lang S, Manlhiot C, Tremoulet AH, Raghuveer G, Selamet Tierney ES, Jone PN, Li JS, Szmuszkovicz JR, Norozi K, Jain SS, Yetman AT, Newburger JW. Association of Acute Anti-inflammatory Treatment With Medium-term Outcomes for Coronary Artery Aneurysms in Kawasaki Disease. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:174-183. [PMID: 37969928 PMCID: PMC10642124 DOI: 10.1016/j.cjcpc.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2023]
Abstract
Background The impact of adjunctive anti-inflammatory treatment on outcomes for patients with Kawasaki disease (KD) and coronary artery aneurysms (CAAs) is unknown. Methods Using data from the International KD Registry in patients with ≥ medium CAA we evaluate associations of treatment with outcomes and major adverse cardiac events (MACE). Results Medium or large CAA was present in 527 (32%) patients. All were treated with intravenous immunoglobulin (IVIG), 70% were male, and the median age was 1.3 years (interquartile range: 0.4-4.0 years). The most common acute therapies included single IVIG alone in 243 (46%), multiple IVIG in 100 (19%), multiple IVIG + corticosteroids in 75 (14%), and multiple IVIG + infliximab + corticosteroids in 44 (8%) patients. Patients who received therapy beyond single IVIG had a larger CA z-score at baseline (P < 0.001) and a higher rate of bilateral CAA (P < 0.001). Compared with IVIG alone, early adjunctive treatments (within 3 days of initial IVIG) were not associated with time to CAA regression or MACE, whereas later adjunctive therapy was associated with MACE and longer time to CAA regression. Patients receiving IVIG plus steroids vs IVIG alone had a trend towards shorter time to CAA regression and lower risk of MACE (P = 0.07). A larger CAA z-score at baseline was the strongest predictor of an increase in the CAA z-score over follow-up, lower likelihood of CAA regression, and higher risk of MACE. Conclusions Persistence of CAA and MACE are more strongly associated with baseline severity CAA than with acute adjuvant anti-inflammatory therapy. Patients who received late adjunctive therapy are at higher risk for worse outcomes.
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Affiliation(s)
- Kevin G. Friedman
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian W. McCrindle
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Runeckles
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, Québec, Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, the George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Michael Khoury
- Department of Pediatrics, Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Sean Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cedric Manlhiot
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adriana H. Tremoulet
- Department of Pediatrics, Rady Children’s Hospital-San Diego, University of California San Diego, San Diego, California, USA
| | - Geetha Raghuveer
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Elif Seda Selamet Tierney
- Department of Pediatrics, Division of Pediatric Cardiology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Pei-Ni Jone
- Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer S. Li
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Kambiz Norozi
- Division of Cardiology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Supriya S. Jain
- Maria Fareri Children’s Hospital at Westchester Medical Center Health, New York Medical College, Valhalla, New York, USA
| | - Angela T. Yetman
- Department of Pediatrics, Children’s Hospital & Medical Center of Omaha, Omaha, Nebraska, USA
| | - Jane W. Newburger
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Dinsmore N. Paediatric Active Enhanced Disease Surveillance (PAEDS) 2019: Prospective hospital-based surveillance for serious paediatric conditions. COMMUNICABLE DISEASES INTELLIGENCE (2018) 2021; 45. [PMID: 34587877 DOI: 10.33321/cdi.2021.45.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is an Australian hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2019. Methods Specialist nurses screened hospital admissions, emergency department records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia, to identify children with the conditions under surveillance. Standardised protocols and case definitions were used across all sites. In 2019, the conditions under surveillance comprised: acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases and two new conditions, Kawasaki disease and gram-negative bloodstream infections. An additional social research component continued to evaluate parental attitudes to influenza vaccination. Results PAEDS captured 2,701 cases for 2019 across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets for detection of poliomyelitis cases; demonstration of high influenza activity in 2019 and influenza-associated deaths in ACE cases; identification of key barriers to influenza vaccination of children hospitalised for acute respiratory illness; reporting of all IS cases associated with vaccine receipt to relevant state health department; and showing a further reduction nationally in varicella cases. Enhanced pertussis surveillance continued to capture controls to support vaccine efficacy estimation. Invasive meningococcal disease surveillance showed predominance of serotype B and a reduction in cases nationally. Surveillance for invasive group A streptococcus captured severe cases in children. Monitoring of Kawasaki disease incidence and gram-negative bloodstream infections commenced. Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using sentinel hospital-based enhanced surveillance. Keywords: paediatric, surveillance, child, hospital, vaccine preventable diseases, adverse event following immunisation, acute flaccid paralysis, encephalitis, influenza, intussusception, pertussis, varicella zoster virus, meningococcal, group A streptococcus, Kawasaki, bloodstream infections.
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Affiliation(s)
- Nicole Dinsmore
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research Institute, The Children's Hospital at Westmead
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Lu Y, Chen T, Wen Y, Si F, Wu X, Yang Y. Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease. BMC Pediatr 2021; 21:406. [PMID: 34530763 PMCID: PMC8444587 DOI: 10.1186/s12887-021-02876-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. METHODS A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. CONCLUSIONS Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.
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Affiliation(s)
- Yaheng Lu
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Tingting Chen
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Yizhou Wen
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Feifei Si
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Xindan Wu
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China.
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Lucas R, Dennington P, Wood E, Dionne A, de Ferranti SD, Newburger JW, Dahdah N, Cheng A, Burgner D, Singh-Grewal D. Variation in the management of Kawasaki disease in Australia and New Zealand: A survey of paediatricians. J Paediatr Child Health 2021; 57:646-652. [PMID: 33296115 DOI: 10.1111/jpc.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to describe the current management practices for Kawasaki disease (KD) in Australia and New Zealand. METHODS We performed a secondary analysis on the Australian and New Zealand responses to a large international survey of clinicians' perspectives on KD diagnosis and management. RESULTS There was general consensus among Australian and New Zealand clinicians regarding the indications for intravenous immunoglobulin and aspirin in the management of acute KD. There was less consensus on the dose of these agents, the definition and management of treatment-resistant KD and the approach to long-term thromboprophylaxis. CONCLUSION Most clinicians use intravenous immunoglobulin for primary treatment of KD. There is variation regarding other aspects of KD diagnosis and important management issues. Future studies should confirm whether this reported variation occurs in real-world practice and assess potential impacts on patient outcome.
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Affiliation(s)
- Ryan Lucas
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia.,Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Peta Dennington
- Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Erica Wood
- Transfusion Research Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Nagib Dahdah
- Department of Pediatric Cardiology, University of Montreal, Montreal, Quebec, Canada
| | - Allen Cheng
- Infectious Disease Epidemiology Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia.,Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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