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Prediction of intravenous immunoglobulin resistance in Kawasaki disease in children

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Abstract

Background

We aimed to explore predictive measures for intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD).

Methods

Patients diagnosed with KD were enrolled in this study. Univariate analysis and multiple logistic regression were utilized to analyze the clinical features and laboratory results prior to IVIG-treatment of the two groups. Independent predictors of IVIG resistance were analyzed, and a predictive model for KD children with IVIG resistance was constructed.

Results

A total of 277 children with KD, 180 boys and 97 girls, aged 2–128 (median 23) months, were enrolled in the study. Compared with the IVIG-responsive group, the IVIG-resistant group had higher levels of the peripheral neutrophil count, mean platelet volume, mean platelet volume-to-lymphocyte ratio and C-reactive protein, and total serum bilirubin, but lower levels of peripheral lymphocyte count, serum albumin and serum prealbumin. Age (in months), peripheral neutrophil count, lymphocyte count and mean platelet volume and serum albumin were independent indicators for IVIG resistance by multivariate logistic regression analysis. A logistic regression model and a scoring system were set up, where cut-off values of − 0.46 and 6.5 points yielded sensitivities of 83.9% and 77.4%, and specificities of 74.8% and 61.0%, respectively. The areas under the curve (AUC) were 0.808 in the logistic regression model, and 0.750 in the scoring system.

Conclusion

Our model for predicting IVIG-resistant children with KD, involving age (months), peripheral neutrophil count, lymphocyte count and mean platelet volume and serum albumin prior to IVIG-treatment, is helpful for clinical prediction of children with IVIG-resistant KD.

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Funding

The work was supported by Peking University Clinical Scientist Program (BMU2019LCKXJ001), and Fundamental Research for the Central Universities.

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Authors and Affiliations

  1. Department of Pediatrics, Peking University First Hospital, No. 1 Xi’an Men Street, Xicheng District, Beijing, China

    Shu Wu, Ying Liao, Yan Sun, Chun-Yu Zhang, Qing-You Zhang, Hui Yan, Jian-Guang Qi, Xue-Qin Liu, Yong-Hong Chen, Yu-Li Wang, Xue-Ying Li, Hong-Fang Jin & Jun-Bao Du

  2. Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China

    Jun-Bao Du

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  1. Shu Wu
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  3. Yan Sun
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Contributions

All authors contributed to all study data, revised and approved the final version of the manuscript. SW and JD designed the study, SW, YL, YS, CZ, HY, QZ, JQ, YC, XL, YW and JD acquired the data. SW, XL, HJ and JD analyzed the data, SW, HJ and JD drafted the manuscript.

Corresponding author

Correspondence to Jun-Bao Du.

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Ethical approval

This study was approved by the Regional Ethics Committee of Peking University, First Hospital.

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No financial or non- financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Wu, S., Liao, Y., Sun, Y. et al. Prediction of intravenous immunoglobulin resistance in Kawasaki disease in children. World J Pediatr 16, 607–613 (2020). https://doi.org/10.1007/s12519-020-00348-2

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