Abstract
Accurate evaluation of individual risk of intravenous immunoglobin (IVIG)-resistance is critical for adopting regimens for the first treatment and prevention of coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods: The KD patients hospitalized in Chongqing Children’s Hospital, in west China, from October 2007 to December 2017 were retrospectively reviewed. Data were collected and compared between IVIG-resistant group and IVIG-responsive group. The independent risk factors were determined using multivariate regression analysis. A new prediction model was built and compared with the previous models. Results: A total of 5277 subjects were studied and eight independent risk factors were identified including higher red blood cell distribution width (RDW), lower platelet count (PLT), lower percentage of lymphocyte (P-LYM), higher total bile acid (TBA), lower albumin, lower serum sodium level, higher degree of CALs (D-CALs) and younger age. The new predictive model showed an AUC of 0.74, sensitivity of 76% and specificity of 59%. For individual’s risk probability of IVIG-resistance, an equation was given. Conclusions: IVIG-resistance could be predicted by RDW, PLT, P-LYM, TBA, albumin, serum sodium level, D-CALs and age. The new model appeared to be superior to those previous models for KD population in Chongqing city.
Highlights
Kawasaki disease (KD) is an acute autoimmune systemic vasculitis disease, mainly affecting young children and characterized by bilateral conjunctival inflammation, atypical rash, etc
The sensitivity and specificity of Kobayashi model were reported as 86.0% and 67.0% respectively when applied in the Japanese population while as 48.8% and 71.6% when applied in 1177 Chinese KD patients[15]
According to univariate analysis (Table 1), 24 variables were significantly higher in the intravenous immunoglobin (IVIG)-resistant group than in the IVIG-responsive group, including RDWa, red blood cell distribution width (RDW), erythrocyte morphology, mean platelet volume (MPV), platelet distribution width (PDW), Neutrophil count, Percentage of neutrophil, platelet-large-cell ratio (P-LCR), GGT, alanine transaminase (ALT), AST, lactic dehydrogenase, total bile acid (TBA), direct bilirubin (DBIL), total bilirubin (TBIL), creatinine, blood urea nitrogen (BUN), uric acid (UA), urine protein, leucocyte morphology, urobilirubin, white blood cell, C-reactive protein (CRP) and D-coronary artery lesions (CALs); 18 items were significantly lower in the IVIG-resistant group including RBC, PCV, thrombocytocrit, platelet count (PLT), lymphocyte, HB, percentage of lymphocyte (P-LYM), LNR, AST/ALT, total protein (TP), albumin, PALB, serum inorganic phosphorus, serum sodium, serum potassium, serum magnesium, serum calcium and age
Summary
Kawasaki disease (KD) is an acute autoimmune systemic vasculitis disease, mainly affecting young children and characterized by bilateral conjunctival inflammation, atypical rash, etc. IVIG-resistance[5,8,9,10,11,12] Based on those risk factors, some prediction models for IVIG-resistant KD were established, including Fukunishi[3], Egami[8], Kobayashi[9] and Sano[5] scoring system from Japan and Yang[10] et al, Wang[11] et al and Tang[12] et al models from China. Those prediction methods, have limitations considering they are specific for Japan, North China and East China. The predictive ability, sensibility and specificity of our new model were further compared with the previously established models including Egami[8], Kobayashi[9] and Sano[5] scoring system from Japan and the model established by Yang[10] et al from China
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