Korean J Pediatr Infect Dis.  2014 Apr;21(1):29-36.

Prediction of Intravenous Immunoglobulin Nonresponse Kawasaki Disease in Korea

• Choi MH
• Park CS
• Kim DS
• Kim KH

Abstract

PURPOSE
The objective of this study was to find the predictors and generate a prediction scoring model of nonresponse to intravenous immunoglobulin in patients with Kawasaki disease.
METHODS
We examined 573 children diagnosed with KD at the Severance Children's Hospital between January 2009 and december 2012. We retrospectively reviewed their medical records. These patients were divided into 2 groups; the experimental group (N=433) and the validation group (N=140). Each group were divided into 2 groups the intravenous immunoglobulin nonresponders and the responders. Multivariate logistic regression analysis identified predictive factors of intravenous immunoglobulin nonresponders which make predictive scoring model. We practice internal validation and external validation.
RESULTS
Multivariate logistic regression analysis identified male, cervical lymphadenopathy, changes of the extremities, platelet, total bilirubin, alkaline phophatase, lactate dehydrogenase, C-reactive protein as significant predictors for nonresponse to intravenous immunoglobulin. We generated prediction score assigning 1 point for (1) male, (2) cervical lymphadenopathy, (3) changes of the extremities, (4) platelet (< or =368,000/mm3), (5) total bilirubin (> or =0.4 mg/dL), (6) alkaline phophatase (> or =227 IU/L), (7) lactate dehydrogenase (> or =268 IU/L), (8) C-reactive protein (>77.1 mg/dL). Using a cut-off point of 4 and more with this prediction score, we could identify the intravenous immunoglobulin nonresponder group. Sensitivity and specificity were 52.5% and 82.4% in experimental group and 37.8% and 81.8% in validation group, respectively.
CONCLUSION
Our predictive scoring models had high specificity and low sensitivity in Korean patients. Therefore it is useful in predicting nonresponse to intravenous immunoglobulin with Kawasaki disease.

Keyword

Kawasaki disease; Nonresponse; Intravenous immunoglobulin; Prediction; Risk factors

MeSH Terms

Bilirubin
Blood Platelets
C-Reactive Protein
Child
Extremities
Humans
Immunoglobulins*
Korea
L-Lactate Dehydrogenase
Logistic Models
Lymphatic Diseases
Male
Medical Records
Mucocutaneous Lymph Node Syndrome*
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Bilirubin
C-Reactive Protein
Immunoglobulins
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1 Receiver-operating-characteristics curves of predictive models for intravenous immunoglobulin nonresponse Kawasaki disease. Predictive model based on logistic regression model (Null) and predictive scoring model (Score Model).

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