Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-06, Vol.113 (22), p.2606-2612
• Main Authors: KOBAYASHI, Tohru, INOUE, Yoshinari, TAKEUCHI, Kazuo, OKADA, Yasunori, TAMURA, Kazushi, TOMOMASA, Takeshi, KOBAYASHI, Tomio, MORIKAWA, Akihiro
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aspartate Aminotransferases - blood; Biological and medical sciences; Blood and lymphatic vessels; C-Reactive Protein - analysis; Cardiology. Vascular system; Child; Coronary Artery Disease - prevention & control; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Forecasting; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunomodulators; Leukocyte Count; Logistic Models; Male; Medical sciences; Middle Aged; Mucocutaneous Lymph Node Syndrome - blood; Mucocutaneous Lymph Node Syndrome - drug therapy; Mucocutaneous Lymph Node Syndrome - immunology; Multivariate Analysis; Pharmacology. Drug treatments; Platelet Count; Predictive Value of Tests; Retrospective Studies; ROC Curve; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sodium - blood; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.592865

In the present study, we developed models to predict unresponsiveness to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD). 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. Our predictive models showed high sensitivity and specificity in identifying IVIG nonresponders among KD patients.