A novel model for predicting intravenous immunoglobulin-resistance in Kawasaki disease: a large cohort study

Abstract

BackgroundPredicting intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) can aid early treatment and prevent coronary artery lesions. A clinically consistent predictive model was developed for IVIG resistance in KD.MethodsIn this retrospective cohort study of children diagnosed with KD from January 1, 2016 to December 31, 2021, a scoring system was constructed. A prospective model validation was performed using the dataset of children with KD diagnosed from January 1 to June 2022. The least absolute shrinkage and selection operator (LASSO) regression analysis optimally selected baseline variables. Multivariate logistic regression incorporated predictors from the LASSO regression analysis to construct the model. Using selected variables, a nomogram was developed. The calibration plot, area under the receiver operating characteristic curve (AUC), and clinical impact curve (CIC) were used to evaluate model performance.ResultsOf 1975, 1,259 children (1,177 IVIG-sensitive and 82 IVIG-resistant KD) were included in the training set. Lymphocyte percentage; C-reactive protein/albumin ratio (CAR); and aspartate aminotransferase, sodium, and total bilirubin levels, were risk factors for IVIG resistance. The training set AUC was 0.825 (sensitivity, 0.723; specificity, 0.744). CIC indicated good clinical application of the nomogram.ConclusionThe nomogram can well predict IVIG resistance in KD. CAR was an important marker in predicting IVIG resistance in Kawasaki disease.

Knowledge framework of intravenous immunoglobulin resistance in the field of Kawasaki disease: A bibliometric analysis (1997−2023)

“…The combination of high-dose IVIG and aspirin is the initial treatment for KD, but up to 20% of patients do not respond to IVIG therapy, presenting with persistent or recurrent fever 24−48 h after completion of the first dose of IVIG, and an increased risk of coronary artery abnormalities. 38,39 According to the guidelines developed by the American College of Rheumatology in 2021, glucocorticoids or other immunomodulatory immunosuppressants in combination with IVIG are recommended for the treatment of IVIG-resistant KD. 40 Several trials have been conducted to study the treatment of steroids in high-risk IVIG-resistant patients.…”

“…[20][21][22] These models have different sensitivities and specificities, and it is worth noting that these scoring systems cannot be applied to different populations. 38 Adriana H. Tremoulet, who established the San Diego predictive scoring system for IVIG resistance, which has a sensitivity of 73.3% and a specificity of 61.9%, had three reference citation bursts. 30 Accurate identification of IVIG resistance is a major challenge in the treatment of KD, and early identification of IVIG resistance is essential for timely additional treatment.…”

“…Fever duration, white blood cell count, lymphocyte percentage, neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, aspartate aminotransferase, hematocrit, albumin, total bilirubin, lactate dehydrogenase, creatinine, and sodium have been used to predict IVIG resistance in KD in several studies. 38,39,50 Based on laboratory findings and clinical features at the time of initial treatment, three IVIG risk prediction models have been established by logistic regression analysis and verified externally. [20][21][22] ML can handle nonlinear input variables and therefore sometimes outperforms traditional models.…”