| アブストラクト | OBJECTIVE: Several studies revealed the efficacy of glucocorticoids on prevention of coronary artery lesions (CALs) in Kawasaki disease (KD) patients. However, impacts of different doses of glucocorticoids on clinical outcomes of KD remain unknown. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we evaluated KD patients who were treated with normal-dose (prednisolone 0.5-4.0 mg/kg/day) or high-dose (methylprednisolone 10-40 mg/kg/day) glucocorticoids. We investigated risks of CALs and readmission, total hospitalization cost, and length of hospital stay in the acute phase of KD using propensity score matching, stabilized propensity-score inverse probability of treatment weighting, and instrumental variable methods. RESULTS: We identified a total of 3,220 patients with KD who were treated with normal-dose (n = 2,453) or high-dose (n = 767) glucocorticoids in addition to intravenous immunoglobulin. One-to-one propensity-matched analyses with 744 pairs demonstrated no significant differences between the normal-dose and the high-dose groups in risk of CALs (risk ratio [RR] 0.83, 95% confidence interval [95% CI] 0.49, 1.40) and risk of readmissions (RR 0.85, 95% CI 0.65, 1.11). Stabilized propensity-score inverse probability weighting and instrumental variable analyses showed similar results to the propensity score matching analyses. CONCLUSION: Risks of CALs and readmissions and total hospitalization costs were similar between the normal-dose and the high-dose glucocorticoids groups for patients with KD, whereas total length of hospital stay was shorter in the high-dose group than that in the normal-dose group. |
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| ジャーナル名 | Arthritis care & research |
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| 投稿日 | 2017/10/27 |
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| 投稿者 | Okubo, Yusuke; Michihata, Nobuaki; Morisaki, Naho; Sundel, Robert P; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo |
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| 組織名 | National Center for Child Health and Development, School of Public Health,;University of Tokyo, Tokyo, Japan, and Fielding School of Public Health,;University of California, Los Angeles.;School of Public Health, University of Tokyo, Tokyo, Japan.;University of Tokyo, Tokyo, Japan.;Boston Children's Hospital, Boston, Massachusetts.;Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/29073349/ |
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