Decreased hemoglobin after initial treatment is associated with treatment resistance in Kawasaki disease in Kobayashi ri
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BRIEF REPORT
Decreased hemoglobin after initial treatment is associated with treatment resistance in Kawasaki disease in Kobayashi risk stratification Yukari Atsumi1,6 · Hiroshi Sakakibara1 · Yoshihiko Morikawa2 · Koichi Miyata3 · Hiroyuki Yamagishi4 · Masahiro Misawa5 · Masaru Miura2,3 Received: 16 October 2019 / Accepted: 31 July 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background Although Kawasaki disease (KD) is known to cause anemia, the relationship between its prognosis and hemoglobin level is less well known. Methods We herein performed a secondary analysis of data from a previous study (Post-RAISE). Children aged 6 months to 2 years at the time of KD diagnosis were enrolled. Decreased hemoglobin was defined as a decrease > 10% on post-treatment day 2 compared with the level prior to the initial therapy. Results Of 1253 KD cases, treatment resistance was observed in 209 (17%) and was significantly more frequent in the decreased hemoglobin group (37/167 vs. 172/1086, P = 0.041). Multivariable logistic regression analysis revealed that decreased hemoglobin was associated with resistance to the initial treatment (odds ratio 1.53; 95% confidence interval 1.00–2.33; P = 0.048). Conclusions Decreased hemoglobin was significantly associated with resistance to initial treatment in patients with KD. Keywords Anemia · Inflammation · Hepcidin · Kawasaki disease
Introduction Kawasaki disease (KD) is an acute childhood vasculitis marked by a constellation of fever and various acute inflammatory features [1]. The chief complication is coronary artery lesion (CAL) development. Intravenous immunoglobulin (IVIG) and oral aspirin can reduce CAL incidence to less than 5% [2]. * Yukari Atsumi [email protected] 1
Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
2
Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
3
Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
4
Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
5
Department of Pediatrics, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
6
National Center for Global Health and Medicine, 1‑21‑1, Toyama, Shinjuku‑ku, Tokyo 162‑8655, Japan
Inflammatory diseases, including KD, are known to cause anemia. Huang et al. described the transition of hemoglobin, serum iron, interleukin (IL)-6, and hepcidin in KD [3, 4]. The hemoglobin level is associated with hepcidin, a hormone involved in iron bioavailability, and erythropoiesis [5, 6]. Their reports suggested that the increase of hepcidin seen during inflammation was related to anemia and KD prognosis. However, the relationship between KD prognosis and hemoglobin is not fully understood. Various cytokines are involved in KD [7, 8]. However, detecting and measuring cytokines are costly and timeintensive. The present study aimed to clarify the relationship between the decreased hemoglobin after the initial treat
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