Effectiveness of Initial Corticosteroid Treatment in Kawasaki Disease Children Suspected to be IVIG Resistant

This retrospective study assessed the efficacy of initial treatment with intravenous immunoglobulin (IVIG), aspirin, and corticosteroids in Kawasaki disease (KD) patients at risk for IVIG resistance. Data from pediatric patients with KD between January 2010 and December 2019 were divided into the IVIG-sensitive and IVIG-resistant groups based on treatment response. Risk factors for IVIG resistance were identified through univariate analysis. Outcomes included comparison of fever resolution time, hospital stay, and coronary artery lesion (CALs) incidence at multiple intervals post-treatment. An observational group (January 2020 to December 2022) was given additional methylprednisolone if they exhibited three or more IVIG resistance risk factors. The IVIG-resistant group had a higher proportion of males and significantly elevated inflammatory markers (CRP, ESR, PCT) and TBIL, NT-proBNP compared to the IVIG-sensitive group (all p < 0.05), while showing lower levels of albumin, ARR (AST/ALT ratio), and serum sodium (all p < 0.05). Both the IVIG-sensitive and observational groups had significantly shorter fever resolution times and hospital stays than the IVIG-resistant group (all p < 0.05). CALs incidence was consistently higher in the IVIG-resistant group across all follow-up periods (all p < 0.05), with significant differences observed between the observational group and IVIG-resistant group at 1-month, 3-month, and 6-month post-treatment (all p < 0.05). Notably, prior to treatment, the observational group had a higher CALs incidence compared to the IVIG-sensitive group (all p < 0.05). In children with KD who exhibit ≥ 3 risk factors for IVIG non-response, initial treatment with IVIG, aspirin, and glucocorticoids can effectively reduce fever duration, hospitalization duration, and incidence of CALs and is considered safe.