A New Diagnostic Model to Distinguish Kawasaki Disease From Other Febrile Illnesses in Chongqing: A Retrospective Study on 10,367 Patients.

Zhilin Huang,Tie-Wei Lv,Bo Pan,Jie Tian,Xu-Hai Tan,Haolin Wang

doi:10.3389/fped.2020.533759

Abstract

Objective: Kawasaki disease (KD) is one of the most prevailing vasculitis among infants and young children, and has become the leading cause of acquired heart disease in childhood. Delayed diagnosis of KD can lead to serious cardiovascular complications. We sought to create a diagnostic model to help distinguish children with KD from children with other febrile illnesses [febrile controls (FCs)] to allow prompt treatment.Methods: Significant independent predictors were identified by applying multivariate logistic regression analyses. A new diagnostic model was constructed and compared with that from diagnostic tests created by other scholars.Results: Data from 10,367 patients were collected. Twelve independent predictors were determined: a lower percentage of monocytes (%MON), phosphorus, uric acid (UA), percentage of lymphocyte (%LYM), prealbumin, serum chloride, lactic dehydrogenase (LDH), aspartate aminotransferase: alanine transaminase (AST: ALT) ratio, higher level of globulin, gamma-glutamyl transpeptidase (GGT), platelet count (PLT), and younger age. The AUC, sensitivity, and specificity of the new model for cross-validation of the KD diagnosis was 0.906 ± 0.006, 86.0 ± 0.9%, and 80.5 ± 1.5%, respectively. An equation was presented to assess the risk of KD, which was further validated using KD (n = 5,642) and incomplete KD (n = 809) cohorts.Conclusions: Children with KD could be distinguished effectively from children with other febrile illnesses by documenting the age and measuring the level of %MON, phosphorus, UA, globulin, %LYM, prealbumin, GGT, AST:ALT ratio, serum chloride, LDH, and PLT. This new diagnostic model could be employed for the accurate diagnosis of KD.

Highlights

Kawasaki disease (KD) is a vasculitis of unknown etiology that, in general, occurs in childhood and is the most common cause of acquired heart disease [1]
The level of 32 variables was significantly lower in the KD group than that in the febrile controls (FCs) group: RDWa; red blood cell distribution width (RDW); packed cell volume (PCV); abnormal erythrocyte morphology; mean platelet volume (MPV); red blood cell count (RBC); platelet distribution width (PDW); mean corpuscular hemoglobin (MCH); mean corpuscular volume (MCV); total number of lymphocytes; abnormal leukocyte morphology; %LYM; %MON; P-LCR; HB; ovum in stools; AST; AST:alanine transaminase (ALT) ratio; lactic dehydrogenase (LDH); alkaline phosphatase (ALP); total protein (TP); albumin; prealbumin; creatinine; blood urea nitrogen (BUN); uric acid (UA); phosphorus; age; serum levels of sodium, chloride, potassium, and magnesium
For multivariate logistic regression analyses, we selected significant variables derived from the univariate analysis through least absolute shrinkage and selection operator (LASSO) constraints to balance accuracy and simplicity

Summary

Introduction

Kawasaki disease (KD) is a vasculitis of unknown etiology that, in general, occurs in childhood and is the most common cause of acquired heart disease [1]. The incidence of KD is highest in children who live in East Asia or who are of Asian ancestry living in other parts of the world [2,3,4,5]. Coronary-artery aneurysms (CAAs) develop in about 15–25% of children who have not been treated for KD [6]. These CAAs are associated mainly with occlusion of coronary arteries and cardiac ischemia, which can result in increased morbidity and even mortality

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