J Korean Med Sci.  2017 Dec;32(12):1991-1996. 10.3346/jkms.2017.32.12.1991.

Verification of Current Risk Scores for Kawasaki Disease in Korean Children

• Shin J
• Lee H
• Eun L

• KMID: 2396376
• DOI: http://doi.org/10.3346/jkms.2017.32.12.1991

Abstract

The purpose of this study was to evaluate and assess the compatibility of current risk scoring systems from Japan that were developed to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). The authors previously investigated another prediction model for patients with refractory KD in Korea. A retrospective study involving 350 patients with KD who were admitted between January 2014 and December 2015 was performed. Patients younger than 2 years were excluded for the propensity score matching in this study. Patients were classified into IVIG responders and IVIG resistance groups. The well-known Harada, Kobayashi, and Egami risk scores were calculated for each patient, and the proportion of high-risk patients was compared between the two groups for each risk score. Logistic regression analysis revealed that platelets, C-reactive protein (CRP) levels, and aspartate aminotransferase levels were independent predictors of IVIG resistance. Multivariate analysis suggested that platelets and CRP were risk factors. Risk-scoring systems from Japan have good specificity but low sensitivity. Among the three risk scoring systems, the Kobayashi risk score demonstrated significant differences between the IVIG resistance and IVIG responder groups in Korean patients with KD. It is very important to identify IVIG-resistant patients to protect them from ongoing coronary arterial lesion(s); therefore, early prediction and timely optimal additional treatment is of significant benefit. It would be helpful to construct a highly sensitive, exclusive scoring system for Korean patients with KD.

Keyword

Kawasaki Disease; Intravenous Immunoglobulin; Resistance; Prediction; Risk Score

MeSH Terms

Aspartate Aminotransferases
C-Reactive Protein
Child*
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Japan
Korea
Logistic Models
Mucocutaneous Lymph Node Syndrome*
Multivariate Analysis
Propensity Score
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Aspartate Aminotransferases
C-Reactive Protein
Immunoglobulins
Immunoglobulins, Intravenous

Figure

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  Fig. 1 Jitter plots: comparison for age matching.

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  Fig. 2 ROC curve and area under the curve comparison. ROC = receiver operating characteristic.

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  Fig. 3 Nomograms predicting the probability of IVIG resistance in patients with KD. IVIG = intravenous immunoglobulin, KD = Kawasaki disease, Plt = platelets, CRP = C-reactive protein, mo = months, k = 103/μL

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