Kawasaki Disease IVIG Resistance (Harada Variant) Calculator

Kawasaki Disease IVIG Resistance (Harada Variant): Explanation and Clinical Context The Harada score is a clinical prediction tool developed to identify patients with Kawasaki Disease (KD) who are at increased risk of resistance to intravenous immunoglobulin (IVIG) therapy. IVIG resistance occurs in approximately 10–20% of KD patients and is associated with persistent fever, prolonged inflammation, and higher risk of coronary artery aneurysm formation. The Harada score was first developed from a Japanese cohort, integrating eight clinical and laboratory parameters: total bilirubin, AST, CRP, hematocrit, platelet count, age, illness duration before IVIG, and serum sodium.

Each positive criterion contributes one point to the total score, with a maximum of 8. A total score of 4 or more predicts a higher likelihood of IVIG resistance. Clinicians can use this score to stratify patients and consider early intensified therapy, such as corticosteroids or biologic agents, especially in those at high risk.

However, it is important to note that performance of the Harada score varies across populations, with reduced accuracy outside Japan. For more contemporary and ethnically inclusive risk modeling, combining Harada with Kobayashi or Egami criteria may improve predictive accuracy.