483. Racial Disparities with IVIG Response and Cardiac Involvement in Kawaski Disease
Session: Poster Abstract Session: Pediatric Viral Infections
Thursday, October 8, 2015
Room: Poster Hall
Background:  Kawasaki disease (KD) is a febrile vasculitis of unknown etiology. The majority of children respond to one dose of IVIG and high-dose aspirin. However, risk factors for non-responders and subsequent cardiac involvement remain unknown. We sought to compare the demographic, clinical, laboratory, and radiographic findings of responders versus non-responders to IVIG in order to better predict those at high risk of refractory disease and coronary artery aneurysm.

Methods:   A retrospective chart review was performed of subjects <18 years of age with at least one of the following: (1) ICD-9 code of 446.1 (acute febrile mucocutaneous lymph node syndrome); (2) Infectious diseases or Cardiology consult for KD; or (3) children with KD mentioned greater than five times in their medical record.  Only subjects admitted to Vanderbilt from January 2001 to June 2011 who received at least one dose of IVIG, had at least 4 days of fever, and had a discharge diagnosis of KD were included. Clinical presentation, lab data, echocardiogram (ECHO), and treatment for KD were abstracted from the medical record.  Responders were defined as subjects who required only one dose of IVIG for clinical resolution of symptoms.

Results: A total of 333 children met inclusion criteria, 64% were male, median age was 2.7 years (0.16-14 years), 61% were White, 23% were Black, and 4.2% were Asian. The median days of fever prior to IVIG treatment was 6 days (range 4-40), with 87% presenting with <10 days of fever. Children presented with conjunctival injection (93%), rash (91%), mucous membrane changes (90%), changes in the extremities (71%), and cervical lymphadenopathy (26%).  81% of children responded to first dose of IVIG, 9% were readmitted, and 2% required PICU admission. Compared to responders, non-responders had lower median age (2.3 vs. 2.9 years, p=0.04), abnormal 1st echo (60% vs. 35%, p=0.001), and were more likely to be Black race (28% vs. 16%, p=0.013). Non-responders were more likely to have coronary aneurysms (31% vs. 12%, p<0.001), while ectasia was similar between groups (59% vs. 59%).

Conclusion:  Compared to responders, non-responders were more likely to be younger, Black race, and to develop a coronary aneurysm.

Daniel Clark, MD, MPH1, Laura Kaufman, BA2, Kara Denby, MD1, Mary-Margaret Fill, MD1, Scott Pletzer, MD3 and Natasha Halasa, MD, MPH, FPIDS2,3, (1)Internal Medicine-Pediatrics, Vanderbilt University, Nashville, TN, (2)School of Medicine, Vanderbilt University, Nashville, TN, (3)Department of Pediatrics, Vanderbilt University, Nashville, TN


D. Clark, None

L. Kaufman, None

K. Denby, None

M. M. Fill, None

S. Pletzer, None

N. Halasa, Sanofi Pasteur: Grant Investigator , Grant recipient , Research grant and Research support
Gilead: Grant Investigator , Research support
Pfizer: Grant Investigator , Grant recipient , Research grant and Research support
Baxter: Grant Investigator , Grant recipient , Research grant and Research support
Biocryst: Grant Investigator , Research support

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