IVIG Resistance in Kawasaki Disease: Clinical and Laboratory Risk Factors and the Potential Role of Administration Timing

Yue Peng,1– 3,* Fengchuan Jing,1– 3,* Dong Liu,4 Bin Li,5 Yanxia Xu,6 Zhongyou Tan,7 Ouyang Chen,7 Yanfeng Yang,8 Feifei Si,8 Wenliang Jiang,9 Cong Li,9 Zhenli Cheng,1– 3 Xue Zhou,1– 3 Siqi Feng,1– 3 Ya Su,1– 3 Qijian Yi1– 3 1Department of Cardiovascular Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China; 2Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, People’s Republic of China; 3National Clinical Key Cardiovascular Specialty, Key Laboratory of Children’s Important Organ Development and Diseases of Chongqing Municipal Health Commission, Chongqing, People’s Republic of China; 4Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Birth Defects, Luzhou, People’s Republic of China; 5Department of Cardiovascular Medicine, Kunming Children’s Hospital, Yunnan, People’s Republic of China; 6Department of Pediatric Cardiovascular Medicine, Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Guizhou, People’s Republic of China; 7Department of Pediatric Cardiovascular Medicine, Chongqing University Three Gorges Hospital, Chongqing, People’s Republic of China; 8Department of Pediatric Cardiovascular Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, People’s Republic of China; 9Department of Pediatric Cardiovascular Medicine, Dazu Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qijian Yi, Email [email protected]: Intravenous immunoglobulin (IVIG) resistance is associated with coronary artery abnormalities in Kawasaki disease (KD) and requires additional therapy. The purpose of this study was to determine independent risk factors for IVIG resistance, investigate the response to IVIG treatment at different time points and determine whether the time option of IVIG treatment altered IVIG resistance.Methods: The clinical data of 6264 KD patients in southwest China were analyzed retrospectively. According to the response to IVIG treatment, the patients were divided into IVIG response group and IVIG resistance group. Multiple logistic regression model was used to identify independent risk factors for IVIG resistance, and trend chi-square test was used to examine the effect of IVIG timing on IVIG resistance.Results: Multivariate analysis showed that IVIG time, WBC, PLT, HB, ALT and Na were independently associated with IVIG resistance, and IVIG time was a key variable for IVIG resistance. In addition, these data suggested that the rate of IVIG resistance was the lowest when treated with IVIG on the seventh and eighth day of initial fever.Conclusion: IVIG timing is a key factor in IVIG resistance. Our data suggest a lower resistance rate when IVIG is administered on the seventh and eighth day of initial fever. However, the clinical implications of delaying treatment are uncertain, and early IVIG administration remains essential to prevent cardiovascular complications. Further research is needed to validate these findings and to guide clinical practice.Keywords: Kawasaki disease, KD, intravenous immunoglobulin time, intravenous immunoglobulin resistance