The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ≤ 4.0 days after the onset of symptoms were more likely to be IVIG resistant.

Objectives: To explore the characteristics of Kawasaki disease (KD) under 6 months and to investigate the possible indications of incomplete KD (iKD). Methods: The medical records of KD patients hospitalized in Children's Hospital of Soochow University from January 2007 to December 2017 were retrospectively reviewed and analyzed. A total of 50 cases of urinary tract infection (UTI) and 50 cases of adenovirus (ADV)-infected patients under 6 months that were age and gender-matched with the main complaint of high fever were selected as controls. Results: A total of 1,872 KD patients were enrolled. Among them, 194 (10.4%) were infantile patients under 6 months. There were 72 (37.1%) and 494 (29.4%) iKD in patients younger and older than 6 months, respectively (P < 0.05). Although patients under 6 months had a shorter fever duration before immunoglobulin (IVIG) treatment, a larger proportion of these patients had IVIG resistance and coronary artery lesions. They also tended to have higher platelet (PLT) counts and C-reactive protein (CRP) and lower hemoglobin (Hb), percentage of neutrophils (N%), albumin and serum sodium. When we compared iKD under 6 months with UTI and ADV-infected patients, significant differences were found in white blood cells (WBC), Hb, PLT, CRP, N% and serum albumin (P < 0.05). After adjusting the confounders, Hb < 105.5 g/L, CRP > 22.7 mg/L, N% > 47.4 and PLT > 496 × 10⁹/L were indications of iKD when compared with ADV infection (area under the curve [AUC]: 0.872, 0.939, 0.707, and 0.684, respectively). N% > 51.8 and albumin < 39.0 g/L were indications of iKD when compared with UTI (AUC: 0.627 and 0.832, respectively). Conclusions: Infantile KD patients under 6 months had their own particularity. Laboratory variables could be good indications of iKD when compared with UTI and ADV infection.

Background: Kawasaki disease (KD) is an acute febrile illness of unknown etiology and predictors for intravenous immunoglobulin (IVIG) resistance have been widely explored in recent decades. Neutrophil to lymphocyte platelet ratio (NLPR) was reported to be associated with the outcomes in many diseases. However, its relationship with IVIG resistance has not be explored. Methods: The medical data of patients diagnosed with KD in Children’s Hospital of Soochow University between January 2019 and December 2020 were retrospectively reviewed and analyzed. Patients were trisected into three groups based on NLPR. Logistics regression was used to analyze the association between NLPR and IVIG resistance. Restricted cubic spine was used to exhibit the relationship. Sensitivity analysis and subgroup analysis were also carried out. Results: A total of 803 patients were included in the present study (61.8% males; median age: 24 months). IVIG resistance occurred in 74 (9.2%) patients. Multivariable-adjusted analyses revealed higher NLPR (odds ratio [95% confidence interval]: 1.12 [1.00-1.24]) was an independent predictor of IVIG resistance, which was strengthened by sensitivity analyses. The association of NLPR and IVIG resistance was not modified by age, sex, CALs, or days of IVIG initiation ≤ 4. Conclusion: NLPR may be a valuable prognostic marker in KD patients with IVIG resistance.

Background: Kawasaki disease (KD) is a self-limiting vasculitis with an unknown etiology. It has been reported that breastfeeding has a potential protective effect on KD development. However, whether breastfeeding has an effect on the development of coronary artery lesions (CALs) remains unclear. Methods: We retrospectively reviewed the medical records of patients with the main diagnosis of KD hospitalized in our hospital from May 2017 to November 2018. Standardized telephone interviews were carried out to obtain feeding practices before KD was onset. Results: Two hundred and ninety-three (51.6%) were exclusively breastfed, 223 (39.3%) were partially breastfed and 52 (9.2%) were formula fed. There were no significant differences in the characteristics regarding age, gender, incomplete KD, intravenous immunoglobulin (IVIG) resistance, and the laboratory variables among the three groups. With formula feeding as a reference, patients exclusively breastfed and partially breastfed seemed to have a higher incidence of CALs, even after adjusting confounders, but were not statistically significant. After grouping patients who were older than six months into formula feeding, partial breastfeeding for < 2 months, partial breastfeeding for ≥ 2 and < 4 months, partial breastfeeding for ≥ 4 and < 6 months and exclusively breastfeeding based on the length of breastfeeding, the results remained the same (P > 0.05). Conclusions: Breastfeeding has no protective effect on the development of CALs in KD.