Abstract
Backgrounds
This study aimed to identify risk factors for the progression of coronary artery lesions (CALs) in children with Kawasaki disease (KD) and to develop a nomogram prediction model.
Methods
This is a retrospective case-control study in which the participants were categorized into three groups based on the changes of the maximum Z score (Zmax) of coronary arteries at the 1-month follow-up compared with the baseline Zmax: CALs-progressed, CALs-improved, and CALs-unchanged.
Results
Of total 387 patients, 65 (27%), 319 (73%), and 3 (0.7%) patients were categorized into CALs-progressed group, CALs-improved group, and CALs-unchanged group, respectively. Six independent factors associated with CALs progression were identified, including initial IVIG resistance, baseline Zmax, the number of coronary arteries involved, C-reactive protein, albumin, and soluble interleukin-2 receptor (odds ratio: 7.19, 1.51, 2.32, 1.52, 0.86, and 1.46, respectively; all P-values < 0.01). The nomogram prediction model including these six independent risk factors yielded an area under the curve (AUC) of 0.80 (95% confidence interval, 0.74 to 0.86). The accuracy of this model reached 81.7% after the Monte-Carlo Bootstrapping 1000 repetitions.
Conclusions
The nomogram prediction model can identify children at high risk for the progression of CALs at early stages.
Impact
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Six independent factors associated with CALs progression were identified, including initial IVIG resistance, baseline Zmax, the number of coronary arteries involved, CRP, ALB, and sIL-2R.
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The prediction model we constructed can identify children at high risk for the progression of CALs at early stages and help clinicians make individualized treatment plans.
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Prospective, multi-centered studies with larger sample sizes are warranted to validate the power of this prediction model in children with KD.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors would like to thank Dr. Rui Sun for her assistance in data analysis.
Funding
This study was supported by the Clinical and Basic Integration Project of Capital Institute of Pediatrics (Grant No. JHYJ-2023-01)
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Conceptualization/design: D.X., X.-H.L. Funding acquisition: X.-H.L. Methodology: D.X., X.-H.L. Data curation: D.X., C.-H.F. Investigation: D.X., C.-H.F., A.-M.C. Formal analysis: D.X. Supervision/oversight: A.-M.C. Resources: X.-H.L. Writing-Original Draft: D.X. Writing-Review & Editing: Y.-S.C., X.-H.L. Final approval of manuscript: All authors.
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The study protocol was reviewed and approved by the Institutional Review Board of Capital Institute of Pediatrics (Ref. No. SHERLL2023048).
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Xu, D., Chen, YS., Feng, CH. et al. Development of a prediction model for progression of coronary artery lesions in Kawasaki disease. Pediatr Res 95, 1041–1050 (2024). https://doi.org/10.1038/s41390-023-02931-5
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DOI: https://doi.org/10.1038/s41390-023-02931-5
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