Abstract
BackgroundIntravenous immunoglobulin (IVIG) resistance prediction is one of the primary clinical issues and study hotspots in KD. This study aimed to prospectively investigate the value of albumin-bilirubin grade (ALBI) in predicting IVIG resistance in KD and to assess whether ALBI has more predictive value or accuracy than either ALB or TBil alone in predicting IVIG resistance.MethodsA total of 823 patients with KD were prospectively enrolled. The clinical and laboratory data were compared between the IVIG-response group (n = 708) and the IVIG-resistance group (n = 115). Multivariate logistic regression analysis was performed to identify the independent risk factors for IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of ALBI, ALB, and TBil in predicting IVIG resistance.ResultsALBI was significantly higher in patients with IVIG resistance and was identified as an independent risk factor for IVIG resistance in KD. The parameter of ALBI ≥ − 2.57 (AUC: 0.705, 95 %CI: 0.672–0.736), ALB ≤ 33.0 g/L (AUC: 0.659, 95 %CI: 0.626–0.692), and TBil ≥ 16.0µmol/L (AUC: 0.626, 95 %CI: 0.592–0.659), produced a sensitivity, specificity, PPV, and NPV of 0.617, 0.657, 0.226 and 0.914; 0.374, 0.850, 0.289 and 0.893; 0.269, 0.941, 0.425 and 0.888, respectively.ConclusionsA higher ALBI was an independent risk factor for IVIG resistance in KD. It yielded better predictive ability than ALB and TBil alone for initial IVIG resistance.
Highlights
Kawasaki disease (KD) is an acute systemic vasculitis predominantly affecting children, with coronary artery lesions (CALs) as the most severe sequela [1]
Comparison of clinical data between initial Intravenous immunoglobulin (IVIG)-response group and IVIG-resistance group As shown in Table 1, no significant differences were observed between the two groups regarding sex, fever duration before IVIG treatment, the occurrence of incomplete KD, and typical clinical manifestations of KD (p > 0.05)
The results showed that albumin-bilirubin grade (ALBI) ≥ − 2.57 was an independent risk factor for initial IVIG resistance (OR: 3.374, 95 %CI: 2.016–5.648, p < 0.001)
Summary
Kawasaki disease (KD) is an acute systemic vasculitis predominantly affecting children, with coronary artery lesions (CALs) as the most severe sequela [1]. Neither was suitable alone to be a valuable predictor without high sensitivities or specificities Even though both indicators were included in several risk-scoring systems for IVIG resistance prediction in KD [13, 28,29,30,31,32], these riskscoring systems are based on individual parameters that are scored based on arbitrarily defined predetermined cutoff values, producing variable predictive ability for IVIG resistance [14,15,16]. The predictive ability of ALB, TBil, or available risk-scoring systems comprising ALB and/or TBil, seems to be limited and unsatisfactory for IVIG resistance It indicated the necessity and importance of developing a useful and stable predictor for initial IVIG resistance. This study aimed to prospectively investigate the value of albumin-bilirubin grade (ALBI) in predicting IVIG resistance in KD and to assess whether ALBI has more predictive value or accuracy than either ALB or TBil alone in predicting IVIG resistance
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