A New Scoring System for Prediction of Intravenous Immunoglobulin Resistance of Kawasaki Disease in Infants Under 1-Year Old.

Shu Wu,Yong Zhang,Yan Sun,Chunyu Zhang,Yaqian Huang,Junbao Du,Jianguang Qi,Yonghong Chen,Xueqin Liu,Yuan Long,Ying Liao,Hui Yan,Selena Chen,Qingyou Zhang

doi:10.3389/fped.2019.00514

Abstract

Background: Children with Kawasaki disease (KD) under 1-year old are at high risk for intravenous immunoglobulin (IVIG) resistance. The study was designed to explore the predictive measure of IVIG resistance in infants under 1-year old with KD.Methods: This study enrolled children under 1-year old suffering from KD in Peking University First Hospital and Wuhan Children's Hospital. All infants were divided into IVIG-responsive and IVIG-resistant groups. The differences in demographic characteristics, clinical features, and laboratory examinations were compared and the risk factors of IVIG resistant KD were analyzed. Furthermore, a scoring system was developed for predicting IVIG resistance in KD infants and an external validation was performed.Result: A total of 282 infants (194 boys, median age of 7.0 months) were enrolled in this study, of whom 23 children were IVIG-resistant. Compared with IVIG-responsive infants, those in the IVIG-resistant group had a high neutrophil-to-lymphocyte ratio (NLR), high platelet-to-lymphocyte ratio (PLR), high mean platelet volume-to-lymphocyte ratio (MPVLR) in peripheral blood, and low serum albumin, and low serum sodium before IVIG therapy (all P < 0.01). Multiple regression analysis indicated that high levels of peripheral NLR and MPVLR, and low levels of serum albumin and serum sodium were independent risk factors for IVIG resistant KD infants. A scoring system, which included peripheral NLR ≥ 2.69 (1 point), MPVLR ≥ 2.78 (1 point), serum albumin ≤ 30.7 g/L (1 point), and serum sodium ≤ 135.2 mmol/L (1 point), was established. A cut-off value of a total score of 2 points or higher yielded a sensitivity of 87.0% and a specificity of 78.4%, with an area under the curve of 0.891. External validation with clinical diagnostic standard showed that a cut-off value of total score of 2 points or higher for predicting the IVIG-resistance yielded a sensitivity of 70.0% and a specificity of 75.1%.Conclusion: For the first time, we proposed a predictive model of IVIG resistance in KD infants under 1-year old. The scoring system, which accounts for baseline peripheral NLR, MPVLR, and serum albumin and sodium, predicts with relatively high sensitivity and specificity for IVIG-resistant infants with KD under 1-year old.

Highlights

Kawasaki disease (KD) commonly presents as an acute autoimmune vasculitis in childhood [1]
Intravenous immunoglobulin (IVIG) resistance occurred in 8.16% of the study subjects
The results indicated that peripheral NLR (≥ 2.69), MPVLR (≥ 2.78), serum albumin (≤ 30.7 g/L), and sodium (≤ 135.2 mmol/L) were independent risk factors for IVIG resistance with OR values of 4.027, 3.860, 3.300, and 3.700, respectively (Table 3)

Summary

Introduction

Kawasaki disease (KD) commonly presents as an acute autoimmune vasculitis in childhood [1]. Intravenous immunoglobulin (IVIG) with oral aspirin can significantly reduce the incidence of coronary artery complications [4]. It is a standardized treatment for KD that is widely accepted [5]. The incidence of IVIG resistance was about 4.9–38.3% in different regions according to particular definition [4, 6,7,8,9]. IVIG resistance represents severe inflammatory response and it is an independent predictor for coronary artery lesions [10,11,12]. Children with Kawasaki disease (KD) under 1-year old are at high risk for intravenous immunoglobulin (IVIG) resistance. The study was designed to explore the predictive measure of IVIG resistance in infants under 1-year old with KD

Methods

Results

Conclusion