Risk factors for nonresponse to therapy in Kawasaki disease

Objective To study the refractory cases of Kawasaki disease (KD) and identify potential risk factors in patients in whom standard therapy fails. Study design A retrospective chart review of patients with KD admitted from January 1, 2002, through December 31, 2006. Demographic, clinical, laboratory, echocardiographic, and therapeutic data were recorded. Results Of 196 patients, 40 (20%) needed re-treatment. The number of refractory cases were 7 (14.3%), 6 (17.1%), 11(28.9%), 10 (24.4%), and 6 (17.6%) for 2002 to 2006, respectively. There were no significant differences in age, sex, ethnicity, number of days with symptoms at diagnosis, white blood cell count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). Refractory patients had higher band counts (22.7% vs 7%), lower albumin levels (3 vs 3.4), and a higher number of abnormal echocardiography results at diagnosis (80% vs 16.1%). Conclusions An elevated band count, low albumin level, and an abnormal initial echocardiography result can be useful tools to identify patients at risk for a more complicated clinical course.