Asymmetric dimethylarginine as a predictive marker for resistance to high-dose intravenous immunoglobulin in Kawasaki disease.

The objective of the study is to investigate whether asymmetric dimethylarginine (ADMA) level is useful for predicting cases of Kawasaki disease (KD) that were refractory to high-dose intravenous immunoglobulin (IVIG) therapy. This prospective study included 132 patients with KD. Serum ADMA levels were compared between the patients who did not respond and did respond to initial IVIG therapy (initial therapy non-responders and responders), and between the patients who did not respond and did respond to additional IVIG therapy (additional therapy non-responders and responders). Of 132 patients with KD, 102 responded and 30 did not respond to initial IVIG therapy. Serum ADMA levels were significantly lower in initial therapy non-responders than in the responders (P = 0.041). The value obtained by dividing serum ADMA levels before initial IVIG therapy by those after the therapy was significantly higher in the 8 additional therapy non-responders than the 22 additional therapy responders (P = 0.016), which indicates that serum ADMA levels in additional therapy non-responders did not increase sufficiently after the initial treatment.

conclusionADMA levels may be useful for the prediction of resistance to additional IVIG therapy. KD patients who did not response to initial IVIG therapy and whose serum ADMA levels do not increase after the initial treatment may need to receive treatments other than additional IVIG therapy, including infliximab and plasma exchange. WHAT IS KNOWN: • Some scoring systems which have been established to predict initial intravenous immunoglobulin (IVIG) treatment failure in Kawasaki disease are relatively accurate, whereas few markers are available to predict which patients will not respond to additional IVIG treatment. WHAT IS NEW: • Asymmetric dimethylarginine levels may be useful for the prediction of resistance to initial and additional IVIG treatment.