Predicting IVIg Nonresponse in Children With Kawasaki Disease

Abstract

Research Article| January 01 2020 Predicting IVIg Nonresponse in Children With Kawasaki Disease AAP Grand Rounds (2020) 43 (1): 8. https://doi.org/10.1542/gr.43-1-8 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Predicting IVIg Nonresponse in Children With Kawasaki Disease. AAP Grand Rounds January 2020; 43 (1): 8. https://doi.org/10.1542/gr.43-1-8 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: immunoglobulins, intravenous, kawasaki's disease Source: Hester GZ, Watson D, Nickel AJ, et al. Identifying patients with Kawasaki disease safe for early discharge: development of a risk prediction model at a US children’s hospital. Hosp Pediatr. 2019; 9(10): 749– 756; doi: https://doi.org/10.1542/hpeds.2019-0049Google Scholar Investigators from multiple institutions conducted a retrospective study to develop a model for predicting which children with Kawasaki disease (KD) will be IV immunoglobulin (IVIg) nonresponders in hopes of identifying low-risk patients who could be discharged from the hospital earlier after receiving an initial dose of IVIg. Study participants were children 0–18 years old with a primary diagnosis of KD and hospitalized at a single, large, urban US children’s hospital. The medical records of study participants were reviewed, and clinical and laboratory data abstracted. The primary study outcome was IVIg nonresponse defined by one or more of the following criteria: (a) documented fever (temperature ≥38.0°C) 36 hours to 7 days after completion of IVIg dose, (b) receipt of a second dose of IVIg ≥20 hours after first dose, or (c) readmission within 7 days for the second dose of IVIg. Candidate clinical and laboratory parameters for inclusion in the prediction model were chosen, and backward stepwise regression was used to develop the final model, with only variables statistically associated with IVIg nonresponse (defined as P<.157) included. The concordance index (area under the receiver operator curve) was used to assess the accuracy of the final model after adjusting for over-optimism. Based on the model, the authors used a cutoff value for estimate of nonresponse of 10% and computed the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of the model for predicting IVIg nonresponse. Data on 430 children with KD who received an initial dose of IVIg were analyzed. A total of 81 (19%) met criteria for IVIg nonresponse. Variables included in the prediction model for IVIg nonresponse included white blood cell count, platelet count, hemoglobin, aspartate aminotransaminase level, serum sodium, serum albumin, maximum temperature 0–6 hours after IVIg, and presentation with classic KD (ie, fever for ≥5 days with at least 4 of 5 clinical features) versus incomplete KD. The adjusted concordance index of the model was 0.70. Using a cutoff value for predicted nonresponse of 10%, the model had a sensitivity of 90.1%, specificity of 30.1%, PPV of 23.0%, and NPV of 92.9%, with 26.3% of study participants classified as low risk. The authors conclude that a model combining clinical and laboratory parameters can be used to predict risk of IVIg nonresponse, and that this model can be used in identifying children who might be discharged sooner after an initial dose of IVIg. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. KD is the most common cause of acquired heart disease in children in developed countries.1 The incidence of KD... You do not currently have access to this content.