title: Verification of risk scores to predict i.v. immunoglobulin resistance in incomplete Kawasaki disease.
abstract: BACKGROUND
  A recent study indicated the efficacy of the addition of prednisolone to i.v. immunoglobulin (IVIG) as initial treatment in patients with higher risk of IVIG resistance. Several different risk scores for predicting IVIG resistance have been proposed, mainly based on typical Kawasaki disease (KD) patients. We investigated the utility of the risk scores to predict IVIG resistance in incomplete KD.
  
  
  METHODS
  Clinical records of incomplete KD patients who received a single dose of IVIG between 2005 and 2012 at Kochi Health Sciences Center were retrospectively reviewed. Patients were classified into an IVIG-responsive group and an IVIG-resistant group. The Kobayashi, Egami, and Sano risk scores were calculated for each patient and the proportion of high-risk patients was compared between the two groups for each risk score.
  
  
  RESULTS
  For 51 incomplete KD patients, Kobayashi (66.7% vs 47.6%, P = 0.253), Egami (55.6% vs 38.1%, P = 0.274), and Sano (57.1% vs 10.8%, P = 0.068) risk scores identified a higher proportion of high-risk patients in the IVIG-resistant group compared with the IVIG-responsive group, but significant difference was not observed. Sano risk score had the highest OR (6.19; 95%CI: 1.00-38.26).
  
  
  CONCLUSIONS
  The proportion of patients identified as being at high risk for IVIG resistance using the Kobayashi, Egami, and Sano risk scores, respectively, was not significantly different between the IVIG-responsive group and the IVIG-resistant group for incomplete KD. Among the three risk scores, the Sano risk score has the best ability to predict IVIG resistance in incomplete KD.
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.|Department of Pediatrics, Okayama University Hospital, Okayama, Japan.
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Kanamitsu
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.|Cardiovascular Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Kakimoto
authors.affiliation: Department of Pediatrics, Okayama University Hospital, Okayama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimada
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yusei
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.|Department of Pediatrics, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ochi
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Tokorodani
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Akane
authors.initials: A
authors.lastname: Kanazawa
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Miyazawa
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Ritsuo
authors.initials: R
authors.lastname: Nishiuchi
authors.affiliation: Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kikkawa
mesh_terms: D019540:Area Under Curve; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: coronary artery lesion; i.v. immunoglobulin; incomplete Kawasaki disease; risk score