ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1602637
Impact of Different Treatment Strategies on Therapeutic Efficacy and Biomarkers in Children with IVIG-Resistant Kawasaki Disease: A Retrospective Cohort Study
Provisionally accepted
- Jinan Children's Hospital, Jinan, China
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Background: Intravenous immunoglobulin (IVIG) is the standard first-line treatment for Kawasaki disease (KD), althoughyet 10%-20% of patients areexhibit resistancet to initial IVIG therapy. This study investigates retreatment strategies and associated biomarkers in IVIG-resistant KD patients.Methods: This retrospective analysis included 68 IVIG-resistant KD patients from the Children's Hospital Affiliated to Shandong University. Patients were categorizedstratified into three retreatment groups: glucocorticoids (GC) (Group A), IVIG retreatment (Group B), and combination therapy (Group C). Clinical characteristics, laboratory parameters, and therapeutic outcomes were compared, with multivariate logistic regression identifying biomarker correlations.Results: Despite significant differences in pre-treatment levels of C-reactive protein (CRP) and alanine aminotransferase (ALT) across groups, the combined overall response rate for all three groups following different retreatment strategies exceeded 98%. Multivariate logistic regression analysis identifiedrevealed that pretreatment eosinophil percentage (EOS%) and albumin (ALB) levels as independent predictors of favorable outcomeswere positively associated with favorable prognosis, while elevated CRP was significantly associated with adverse outcomes. Furthermore, an increase in EOS% was observed after IVIG retreatment, suggesting indicating a possiblepotential modulation of T helper 2 (Th2)Th2 immune responses by this interventiontreatment. Changes in coronary artery dilationZ-scores further supported the potential benefits of GC monotherapy and combination therapy in mitigating acute vascular injury.Conclusions: Both GC and IVIG, either alone or in combination, are effective treatments for IVIG-resistant KD. EOS%, CRP, and ALB may serve as independent prognostic markers in children with IVIG-resistant KD, providing a foundation for personalized retreatment strategies.
Keywords: Kawasaki disease (KD), Intravenous immunoglobulin (IVIg), glucocorticoids (GC), IVIG-resistant, Retrospective study
Received: 08 Apr 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Zhou, Dong, Wei, Ding, Wang, Wu, Kang, Li and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rui Dong, Jinan Children's Hospital, Jinan, China
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