Predictors for intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease.
BACKGROUND
To assess the predictors for intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD).


METHODS
A total of 560 KD patients were reviewed retrospectively, including 410 complete KD (cKD) and 150 incomplete KD (iKD) patients. The laboratory data were compared between the IVIG-resistant and IVIG-responsive groups, as well as between the coronary artery lesions (CALs+) and without coronary artery lesions (CALs-) groups.


RESULTS
In the cKD patients, C-reactive protein (CRP) levels had a sensitivity of 65.52% and a specificity of 62.7% for predicting IVIG-resistance at a cutoff point of >100 mg/L. When albumin <32 g/L, the sensitivity and specificity for predicting IVIG-resistance were 72 and 83.19%, respectively. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels had a sensitivity of 73.91% and a specificity of 76.43% for predicting IVIG-resistance at a cutoff point of >1300 pg/ml. Interleukin-6 levels had a sensitivity of 76.19% and a specificity of 61.59% at a cutoff value of >45 pg/ml. Erythrocyte sedimentation rate (ESR) levels had a sensitivity of 53.26% and a specificity of 64.14% for predicting CALs at a cutoff point of >75 mm/h. In the iKD patients, the sensitivity and specificity for predicting IVIG-resistance were 80 and 54.1% when hemoglobin <110 g/L. When proportion of neutrophils >70%, the sensitivity and specificity for predicting IVIG-resistance were 68 and 66.94%, respectively. ESR levels had a sensitivity of 70.83% and a specificity of 65.81% for predicting IVIG-resistance at a cutoff point of >80 mm/h. NT-proBNP levels had a sensitivity of 78.57% and a specificity of 56.67% for predicting IVIG-resistance at a cutoff point of >360 pg/ml. Interleukin-6 levels had a sensitivity of 70.59% and a specificity of 66.28% at a cutoff value of >25 pg/ml. Interleukin-10 levels had a sensitivity of 64.71% and a specificity of 74.42% for predicting IVIG-resistance at a cutoff value of >8 pg/ml. ESR levels had a sensitivity of 61.82% and a specificity of 65.12% for predicting CALs at a cutoff point of >75 mm/h.


CONCLUSIONS
The white blood cell count, proportion of neutrophils, hemoglobin, CRP, ESR, albumin, NT-proBNP, interleukin-6 and 10 may be effective predictors for IVIG resistance and CALs in KD patients.
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Tian
T
Xie
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Ying
Y
Wang
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Songling
S
Fu
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Wei
W
Wang
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Chunhong
C
Xie
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China.
Yiying
Y
Zhang
Children's Hospital, Zhejiang University School of Medicine, No.57, Zhugan Lane, Hangzhou, 310003, People's Republic of China. gongfangqi@zju.edu.cn.
Fangqi
F
Gong
D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000139:chemically induced*; D004351:Drug Resistance; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D007223:Infant; D015850:Interleukin-6 / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D015850:Interleukin-6; D010446:Peptide Fragments; D012709:Serum Albumin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
Coronary artery lesions; Intravenous immunoglobulin; Kawasaki disease