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Predictive tool for intravenous immunoglobulin resistance of Kawasaki disease in Beijing
  1. Shuai Yang1,
  2. Ruixia Song1,
  3. Junmei Zhang2,
  4. Xiaohui Li1,
  5. Caifeng Li2
  1. 1 Department of Cardiovascular Diseases, Children’s Hospital Capital Institute of Pediatrics, Beijing, China
  2. 2 Department of Rheumatology and Immunology, Beijing Children’s Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr. Xiaohui Li, Department of Cardiovascular Diseases, Children’s Hospital Capital Institute of Pediatrics, Beijing 100020, China; lxhmaggie{at}126.com and Dr. Caifeng Li, Department of Rheumatology and Immunology, Beijing Children’s Hospital, Capital Medical University, Beijing 100020, China; caifeng_li{at}yeah.net

Abstract

Objective To construct a predictive tool for the efficacy of intravenous immunoglobulin (IVIG) therapy in children with Kawasaki disease (KD) in Beijing, China.

Design This was a cohort study. Data set (including clinical profiles and laboratory findings) of children with KD diagnosed between 1 January 2010 and 31 December 2015 was used to analyse the risk factors and construct a scoring system. Data set of children with KD diagnosed between 1 January 2016 and 1 December 2016 was used to validate this model.

Setting Children’s Hospital Capital Institute of Pediatrics and Beijing Children’s Hospital.

Patients 2102 children diagnosed with KD.

Interventions No.

Main outcome measures Responsiveness to IVIG.

Results The predictive tool included C reactive protein ≥90 mg/L (3 points), neutrophil percentage ≥70% (2.5 points), sodium ion concentration <135 mmol/L (3 points), albumin <35 g/L (2.5 points) and total bilirubin >20 μmol/L (5 points), which generated an area under the the receiver operating characteristic curve of 0.77 (95% CI 0.71 to 0.82) for the internal validation data set, and 0.69 (95% CI 0.58 to 0.81) and 0.63 (95% CI 0.53 to 0.72) for two external validation data sets, respectively. If a total of ≥6 points were considered high-risk for IVIG resistance, sensitivity and specificity were 56% and 79% in the internal verification, and the predictive ability was similar in the external validation.

Conclusions The predictive tool is helpful in early screening of high-risk IVIG resistance of KD in the Beijing area. Consequently, it will guide the clinician in selecting appropriate individualised regimens for the initial treatment of this disease, which is important for the prevention of coronary complications.

  • cardiology
  • statistics
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Footnotes

  • SY and JZ contributed equally.

  • Contributors XL and CL designed the study. SY and JZ collected and analysed the data. RS drafted the manuscript and SY revised the paper. XL and CL contributed to the interpretation of the results and critical revision of the manuscript.

  • Funding This work was supported by the Science Foundation for Clinical Technical Innovation Project of the Beijing Municipal Administration of Hospitals (XMLX201612). The funder had no role in this study.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval All procedures regarding this work comply with the ethical standards of the relevant national guidelines on human experimentation and with the Declaration of Helsinki, as revised in 2008. The study was approved by the Ethics Committee of the Capital Institute of Pediatrics (no 2015040).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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