Abstract 127: Usefulness Of Kawasaki Disease Risk-scoring Systems For Initial Intravenous Immunoglobulin Resistance In Korean Patients with Kawasaki Disease

Abstract

Intravenous immunoglobulin (IVIG) infusion in the acute stage is the standard therapy in patients with Kawasaki disease (KD). Although some risk-scoring system made in Japan are widely used, there are few reports that describe the usefulness of risk-scoring systems to predict initial IVIG resistance. This study aimed to investigate which risk-scoring system of KD is the most useful. And this study evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as an additional criteria of risk-scoring system. In this study, 228 patients with a diagnosis of KD who received IVIG treatment were viewed retrospectively. Of these 228 patients, 27 were nonresponders who received additional rescue therapy. The Kobayashi score (responders n=201, non-responders n=27) showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 67 %. The Egami score (responders n=201, non-responders n=27) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 38 % and specificity of 92 %. The Sano score (responders n=108, non-responders n=15) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 52 % and specificity of 90 %. The new risk-scoring system ( Kobayashi risk-scoring + NT-proBNP > 1093 pg/mL, responders n=201, non-responders n=27, high risk ≥ 5 points ) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 71 %. This findings show the new risk-scoring system is helpful in determining patients at risk for non-responders to initial IVIG treatment. This study suggest that in patients with high risk defined as ≥ 5 points, risk calculation by new scoring system are likely to fail to the initial IVIG therapy and may require further rescue therapy in Korean Kawasaki disease patients .