Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease.
BACKGROUND
In the present study, we developed models to predict unresponsiveness to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD).


RESULTS
We reviewed clinical records of 546 consecutive KD patients (development dataset) and 204 subsequent KD patients (validation dataset). All received IVIG for treatment of KD. IVIG nonresponders were defined by fever persisting beyond 24 hours or recrudescent fever associated with KD symptoms after an afebrile period. A 7-variable logistic model was constructed, including day of illness at initial treatment, age in months, percentage of white blood cells representing neutrophils, platelet count, and serum aspartate aminotransferase, sodium, and C-reactive protein, which generated an area under the receiver-operating-characteristics curve of 0.84 and 0.90 for the development and validation datasets, respectively. Using both datasets, the 7 variables were used to generate a simple scoring model that gave an area under the receiver-operating-characteristics curve of 0.85. For a cutoff of 0.15 or more in the logistic regression model and 4 points or more in the simple scoring model, sensitivity and specificity were 86% and 67% in the logistic model and 86% and 68% in the simple scoring model. The kappa statistic is 0.67, indicating good agreement between the logistic and simple scoring models.


CONCLUSIONS
Our predictive models showed high sensitivity and specificity in identifying IVIG nonresponders among KD patients.
Kobayashi
Tohru
T
Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine, Gunma 377-8511, Japan. torukoba@nifty.com
Inoue
Yoshinari
Y
Takeuchi
Kazuo
K
Okada
Yasunori
Y
Tamura
Kazushi
K
Tomomasa
Takeshi
T
Kobayashi
Tomio
T
Morikawa
Akihiro
A
D000293:Adolescent; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003324:Coronary Artery Disease / Q000517:prevention & control; D005260:Female; D005544:Forecasting; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D015999:Multivariate Analysis; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D002097:C-Reactive Protein; D012964:Sodium; D001219:Aspartate Aminotransferases