Abstract
BACKGROUND: Intravenous immunoglobulin (IVIG) is the standard first-line treatment for Kawasaki disease (KD), although 10%-20% of patients are resistant 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 categorized 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 identified pretreatment eosinophil percentage (EOS%) and albumin (ALB) levels as independent predictors of favorable outcomes, while elevated CRP was significantly associated with adverse outcomes. Furthermore, an increase in EOS% was observed after IVIG retreatment, suggesting a possible modulation of T helper 2 (Th2) immune responses by this intervention. Changes in coronary artery dilation further supported the potential benefits of GC monotherapy and combination therapy in mitigating acute vascular injury. CONCLUSION: 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.