Among patients with Kawasaki disease, the incidence of coronary artery lesion is linked to intravenous immunoglobulin (IVIG) resistance, according to study results published in PLoS One.

Kawasaki disease is the leading cause of acquired heart disease in children in developed countries, and may cause coronary artery lesions in this population. Although previous studies have suggested a relationship between coronary artery lesions and IVIG resistance, conclusions have not been consistent.

Study authors conducted a meta-analysis to determine the association between IVIG resistance and coronary artery lesions in children with Kawasaki disease.

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The current analysis (PROSPERO; Study Number: CRD42020181359) was based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Of the 1232 potentially relevant studies, the study authors included 53 studies from 11 countries in their meta-analysis, which included 30,312 patients with Kawasaki disease; 4750 patients were resistant and 25,562 were responsive to IVIG.

There was a significant difference in coronary artery lesion incidence between the IVIG resistance and IVIG response cohorts (odds ratio [OR], 3.89; 95% CI, 3.18-4.75; P <.001). Following an asymmetric distribution in the results of an Egger’s regression test, the study authors reported existence of a publication bias (P =.002); however, no significant difference was reported before and after the trim-and-fill method to evaluate publication bias, suggesting that the findings were still significant.

A Chi-squared test to test heterogeneity revealed an I2 value of 74.8% and the authors speculated that the study regions might have been the sources of heterogeneity. Results of a subgroup analysis also confirmed that the incidence of coronary artery lesion was higher in the IVIG resistance cohort compared with the IVIG responsive cohort under different regions (Asia: OR, 4.80; North America: OR, 2.00; Europe: OR, 2.46).

Some study limitations included the lack of information about adjunct therapies of IVIG resistance in the majority of studies, the lack of reported follow-up time, and the retrospective design of most of the studies.

“Further well-designed studies with uniform criteria are needed to evaluate the incidence of [coronary artery lesion] in IVIG-resistant patients,” the study authors concluded.


Zheng Xi, Li J, Yue P, et al. Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease? -Current evidence based on a meta-analysis. PLoS One. Published online March 25, 2021. doi:10.1371/journal.pone.0248812