A novel nomogram model for differentiating Kawasaki disease from sepsis

Abstract

Kawasaki disease (KD) is a form of systemic vasculitis that occurs in children under the age of 5 years old. Due to prolonged fever and elevated inflammatory markers that are found in both KD and sepsis, the treatment approach differs for each. We enrolled a total of 420 children (227 KD and 193 sepsis) in this study. Logistic regression and a nomogram model were used to analyze the laboratory markers. We randomly selected 247 children as the training modeling group and 173 as the validation group. After completing a logistic regression analysis, white blood cell (WBC), anemia, procalcitonin (PCT), C-reactive protein (CRP), albumin, and alanine transaminase (ALT) demonstrated a significant difference in differentiating KD from sepsis. The patients were scored according to the nomogram, and patients with scores greater than 175 were placed in the high-risk KD group. The area under the curve of the receiver operating characteristic curve (ROC curve) of the modeling group was 0.873, sensitivity was 0.893, and specificity was 0.746, and the ROC curve in the validation group was 0.831, sensitivity was 0.709, and specificity was 0.795. A novel nomogram prediction model may help clinicians differentiate KD from sepsis with high accuracy.

Clinical Implications of Procalcitonin in Kawasaki Disease: A Useful Candidate For Differentiating From Sepsis and Evaluating IVIG Responsiveness

“…In the present study, we compared serum level of PCT among acute KD patients, sepsis patients and the healthy controls, and found that it experienced the highest increase in sepsis patients before antibiotic therapy, followed by acute KD patients and the healthy controls. Consistently, two controlled clinical trials from Chongqing and Guangdong, China [18,19], indicated that serum PCT in acute KD patients had a signi cant increase compared with the healthy controls (1.4 ng/ml vs 0.2 ng/ml), whereas was signi cantly lower than that in sepsis patients (1.4 ng/ml vs 4.1 ng/ml). Based on these current evidence, serum PCT in acute KD patients is almost 7-20 folds higher above baseline, whereas 3-5 folds lower than that in sepsis patients.…”

“…Based on this nding, PCT concentrations below 0.25 ng/ml may be useful for discriminating KD from sepsis. Recently, Liu et al [19] developed a novel nomogram model to differentiate KD from sepsis, in which PCT ≤ 0.5 ng/ml was regarded as a strong predictor for KD with 57 points, and associated with a 3.41-fold increase in KD probability. However, in a retrospective study encompassing 49 KD patients and 24 sepsis patients from Korea, Lee et al [22] divided both KD and sepsis patients into <0.25 ng/ml group, 0.25-1.0 ng/ml group and >1.0 ng/ml group based on PCT concentrations, and found that PCT was not helpful for discriminating KD from sepsis.…”

Clinical implications of procalcitonin in Kawasaki disease: a useful candidate for differentiating from sepsis and evaluating IVIG responsiveness

“…In the present study, we compared serum level of PCT among acute KD patients, sepsis patients and the healthy controls and found that it experienced the highest increase in sepsis patients before antibiotic therapy, followed by acute KD patients and the healthy controls. Consistently, two controlled clinical trials from Chongqing and Guangdong, China [ 20 , 21 ], indicated that serum PCT in acute KD patients had a significant increase compared with the healthy controls (1.4 ng/ml vs 0.2 ng/ml), whereas it was significantly lower than that in sepsis patients (1.4 ng/ml vs 4.1 ng/ml). Based on these current evidence, serum PCT in acute KD patients is almost 7–20 folds higher above baseline, whereas 3–5 folds lower than that in sepsis patients.…”

“…Recently, Liu et al . [ 21 ] have developed a novel nomogram model to differentiate KD from sepsis, in which PCT ≤ 0.5 ng/ml was regarded as a strong predictor for KD with 57 points, and associated with a 3.41-fold increase in KD probability. However, in a retrospective study encompassing 49 KD patients and 24 sepsis patients from Korea, Lee et al .…”

“…Based on this finding, PCT concentrations below 0.25 ng/ml may be useful for discriminating KD from sepsis. Recently, Liu et al [21] have developed a novel nomogram model to differentiate KD from sepsis, in which PCT ≤ 0.5 ng/ml was regarded as a strong predictor for KD with 57 points, and associated with a 3.41-fold increase in KD probability. However, in a retrospective study encompassing 49 KD patients and 24 sepsis patients from Korea, Lee et al [24] divided both KD and sepsis patients into < 0.25 ng/ml group, 0.25-1.0 ng/ml group and > 1.0 ng/ml group based on PCT concentrations and found that PCT was not helpful for discriminating KD from sepsis.…”