From the Department of Pediatric Cardiology.
Department of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
Pediatr Infect Dis J. 2018 Sep;37(9):850-855. doi: 10.1097/INF.0000000000001923.
Diverse scores on high-risk Kawasaki disease (KD) patients have proven a good prognostic validity in the Japanese population. However, data on non-Japanese have been inconclusive. Do the Kobayashi, Egami and Sano scores or application of up-to-date statistical methods (Random Forest) predict response to standard intravenous immunoglobulin (IVIG) therapy and the risk of persistent coronary artery aneurysm (CAA) in patients with KD in a mainly Caucasian population in Germany?
Data on 442 children (German population-based survey, 2013 and 2014) were used to assess the prognostic validity of the Kobayashi, Egami and Sano scores for being refractory to IVIG treatment and for predicting the risk of persistent CAA. Additionally, an up-to-date statistical approach (Random Forest) was applied to identify a potentially more valid score.
A total of 301 children were eligible for assessment of their response to IVIG treatment. Among those, 177 children were followed-up for 1 year to identify persistent CAA. Although all scores were significantly associated with being refractory to IVIG (relative risk range between 2.32 and 3.73), the prognostic properties were low (likelihood ratio positive: 1.83-4.57; sensitivity in the range of 0.28-0.53). None of the scores was a significant predictor of CAA 1 year after acute illness. Application of statistical analysis such as Random Forest did not yield a more valid score.
None of the available scores appears to be appropriate for identifying high-risk Caucasian children with KD who might need intensified therapy.
不同的高危川崎病（KD）评分在日本人群中已被证明具有良好的预后价值。然而，非日本人的数据尚无定论。在以白种人为主的德国人群中，小林、江田和佐野评分或应用最新的统计方法（随机森林）能否预测 KD 患者对标准静脉注射免疫球蛋白（IVIG）治疗的反应和持续性冠状动脉瘤（CAA）的风险？
使用 2013 年和 2014 年德国的一项基于人群的调查中 442 名儿童的数据，评估小林、江田和佐野评分对 IVIG 治疗无效和预测持续性 CAA 风险的预后价值。此外，还应用了最新的统计方法（随机森林）来确定一种可能更有效的评分。
共有 301 名儿童有资格评估其对 IVIG 治疗的反应。其中，177 名儿童接受了 1 年的随访以确定持续性 CAA。尽管所有评分均与 IVIG 治疗无效显著相关（相对风险范围为 2.32-3.73），但预后价值较低（似然比阳性：1.83-4.57；灵敏度范围为 0.28-0.53）。评分均不能作为急性疾病 1 年后发生 CAA 的显著预测因子。应用统计分析，如随机森林，并未产生更有效的评分。
现有的评分均不适宜用于识别可能需要强化治疗的高危白人 KD 儿童。
