Abstract：
BACKGROUND: The optimal therapeutic window to start intravenous immunoglobulin (IVIG) for Kawasaki disease (KD) is highly debatable. We aimed to summarize the existing literature to evaluate the therapeutic window of IVIG treatment and its correlation with clinical outcomes in KD patients.
METHODS: We searched the databases from inception to August 26, 2022, without language restrictions. The primary outcomes were initial IVIG resistance and coronary artery lesions (CALs) in acute phase. Secondary outcome was CALs during 1-2 months of follow-up.
RESULTS: 27 studies involving 41,139 patients were included in this study. Very low-quality evidence showed that the earlier IVIG treatment within 4 days had a higher IVIG-resistance rate (RR, 1.80; 95% CI, 1.50-2.15; P < .00001; I2 = 75%) than the late treatment. Very low-quality evidence showed that IVIG treatment for more than 7 days was associated with a higher risk of CALs in acute phase(RR, 0.57; 95% CI, 0.40-0.80; P = .001; I2 = 76%). There was a lower risk of CALs during 1-2 months follow-up for those who started IVIG administration within 10 days from the onset.
CONCLUSIONS: Overall, IVIG treatment within 7 days of illness seems to be the optimal therapeutic window of IVIG. IVIG treatment within 7 days is found to be effective for reducing the risk of coronary artery lesions and cardiac sequelae in KD patients. The early IVIG treatment within 4 days should be vigilant for the IVIG resistance although large multi-center randomized trials with well design are needed.
METHODS: We searched the databases from inception to August 26, 2022, without language restrictions. The primary outcomes were initial IVIG resistance and coronary artery lesions (CALs) in acute phase. Secondary outcome was CALs during 1-2 months of follow-up.
RESULTS: 27 studies involving 41,139 patients were included in this study. Very low-quality evidence showed that the earlier IVIG treatment within 4 days had a higher IVIG-resistance rate (RR, 1.80; 95% CI, 1.50-2.15; P < .00001; I2 = 75%) than the late treatment. Very low-quality evidence showed that IVIG treatment for more than 7 days was associated with a higher risk of CALs in acute phase(RR, 0.57; 95% CI, 0.40-0.80; P = .001; I2 = 76%). There was a lower risk of CALs during 1-2 months follow-up for those who started IVIG administration within 10 days from the onset.
CONCLUSIONS: Overall, IVIG treatment within 7 days of illness seems to be the optimal therapeutic window of IVIG. IVIG treatment within 7 days is found to be effective for reducing the risk of coronary artery lesions and cardiac sequelae in KD patients. The early IVIG treatment within 4 days should be vigilant for the IVIG resistance although large multi-center randomized trials with well design are needed.
摘要：
背景：开始静脉注射免疫球蛋白（IVIG）治疗川崎病（KD）的最佳治疗窗口是有争议的。我们旨在总结现有文献，以评估KD患者IVIG治疗的治疗窗口及其与临床结局的相关性。
方法：我们从开始到2022年8月26日搜索了数据库，没有语言限制。主要结果是初始IVIG抵抗和急性期的冠状动脉病变（CAL）。次要结果是1-2个月随访期间的CAL。
结果：这项研究纳入了27项研究，涉及41,139名患者。非常低质量的证据表明，在4天内较早的IVIG治疗具有较高的IVIG耐药率（RR，1.80；95%CI，1.50-2.15；P<.00001；I2=75%）比晚期治疗。非常低质量的证据表明，IVIG治疗超过7天与急性期CAL的高风险相关（RR，0.57；95%CI，0.40-0.80；P=.001；I2=76%）。在发病后10天内开始IVIG给药的患者在1-2个月的随访期间CAL的风险较低。
结论：总体而言，发病7天内的IVIG治疗似乎是IVIG的最佳治疗窗口。发现7天内的IVIG治疗可有效降低KD患者的冠状动脉病变和心脏后遗症的风险。尽管需要设计良好的大型多中心随机试验，但4天内的早期IVIG治疗应警惕IVIG耐药性。
方法：我们从开始到2022年8月26日搜索了数据库，没有语言限制。主要结果是初始IVIG抵抗和急性期的冠状动脉病变（CAL）。次要结果是1-2个月随访期间的CAL。
结果：这项研究纳入了27项研究，涉及41,139名患者。非常低质量的证据表明，在4天内较早的IVIG治疗具有较高的IVIG耐药率（RR，1.80；95%CI，1.50-2.15；P<.00001；I2=75%）比晚期治疗。非常低质量的证据表明，IVIG治疗超过7天与急性期CAL的高风险相关（RR，0.57；95%CI，0.40-0.80；P=.001；I2=76%）。在发病后10天内开始IVIG给药的患者在1-2个月的随访期间CAL的风险较低。
结论：总体而言，发病7天内的IVIG治疗似乎是IVIG的最佳治疗窗口。发现7天内的IVIG治疗可有效降低KD患者的冠状动脉病变和心脏后遗症的风险。尽管需要设计良好的大型多中心随机试验，但4天内的早期IVIG治疗应警惕IVIG耐药性。
