Prediction of intravenous immunoglobulin resistance in Kawasaki disease in children
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ORIGINAL ARTICLE
Prediction of intravenous immunoglobulin resistance in Kawasaki disease in children Shu Wu1 · Ying Liao1 · Yan Sun1 · Chun‑Yu Zhang1 · Qing‑You Zhang1 · Hui Yan1 · Jian‑Guang Qi1 · Xue‑Qin Liu1 · Yong‑Hong Chen1 · Yu‑Li Wang1 · Xue‑Ying Li1 · Hong‑Fang Jin1 · Jun‑Bao Du1,2 Received: 29 August 2019 / Accepted: 18 February 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background We aimed to explore predictive measures for intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD). Methods Patients diagnosed with KD were enrolled in this study. Univariate analysis and multiple logistic regression were utilized to analyze the clinical features and laboratory results prior to IVIG-treatment of the two groups. Independent predictors of IVIG resistance were analyzed, and a predictive model for KD children with IVIG resistance was constructed. Results A total of 277 children with KD, 180 boys and 97 girls, aged 2–128 (median 23) months, were enrolled in the study. Compared with the IVIG-responsive group, the IVIG-resistant group had higher levels of the peripheral neutrophil count, mean platelet volume, mean platelet volume-to-lymphocyte ratio and C-reactive protein, and total serum bilirubin, but lower levels of peripheral lymphocyte count, serum albumin and serum prealbumin. Age (in months), peripheral neutrophil count, lymphocyte count and mean platelet volume and serum albumin were independent indicators for IVIG resistance by multivariate logistic regression analysis. A logistic regression model and a scoring system were set up, where cut-off values of − 0.46 and 6.5 points yielded sensitivities of 83.9% and 77.4%, and specificities of 74.8% and 61.0%, respectively. The areas under the curve (AUC) were 0.808 in the logistic regression model, and 0.750 in the scoring system. Conclusion Our model for predicting IVIG-resistant children with KD, involving age (months), peripheral neutrophil count, lymphocyte count and mean platelet volume and serum albumin prior to IVIG-treatment, is helpful for clinical prediction of children with IVIG-resistant KD. Keywords Intravenous immunoglobulin · Kawasaki disease · Resistance · Prediction
Introduction Kawasaki disease (KD) with the highest incidence in the Northeast Asia especially in Japan, Korea and China, is the most common systemic vasculitis in children [1, 2]. In China, despite insufficient nationwide data, the latest epidemiological investigation showed that the incidence of KD was on the increase since 1998 and varied from 68.8 to 107.3 per 100,000 children under five in Shanghai City from 2013 to 2017 [3]. For children with KD, intravenous * Jun‑Bao Du [email protected] 1
Department of Pediatrics, Peking University First Hospital, No. 1 Xi’an Men Street, Xicheng District, Beijing, China
Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
2
immunoglobulin (IVIG) is the first-line therapy; and patients who have repeated or persistent fever af
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