Wu Shu, Long Yuan, Chen Selena, Huang Yaqian, Liao Ying, Sun Yan, Zhang Qingyou, Zhang Chunyu, Yan Hui, Qi Jianguang, Liu Xueqin, Chen Yonghong, Zhang Yong, Du Junbao
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Front Pediatr. 2019 Dec 11;7:514. doi: 10.3389/fped.2019.00514. eCollection 2019.
Children with Kawasaki disease (KD) under 1-year old are at high risk for intravenous immunoglobulin (IVIG) resistance. The study was designed to explore the predictive measure of IVIG resistance in infants under 1-year old with KD. This study enrolled children under 1-year old suffering from KD in Peking University First Hospital and Wuhan Children's Hospital. All infants were divided into IVIG-responsive and IVIG-resistant groups. The differences in demographic characteristics, clinical features, and laboratory examinations were compared and the risk factors of IVIG resistant KD were analyzed. Furthermore, a scoring system was developed for predicting IVIG resistance in KD infants and an external validation was performed. A total of 282 infants (194 boys, median age of 7.0 months) were enrolled in this study, of whom 23 children were IVIG-resistant. Compared with IVIG-responsive infants, those in the IVIG-resistant group had a high neutrophil-to-lymphocyte ratio (NLR), high platelet-to-lymphocyte ratio (PLR), high mean platelet volume-to-lymphocyte ratio (MPVLR) in peripheral blood, and low serum albumin, and low serum sodium before IVIG therapy (all < 0.01). Multiple regression analysis indicated that high levels of peripheral NLR and MPVLR, and low levels of serum albumin and serum sodium were independent risk factors for IVIG resistant KD infants. A scoring system, which included peripheral NLR ≥ 2.69 (1 point), MPVLR ≥ 2.78 (1 point), serum albumin ≤ 30.7 g/L (1 point), and serum sodium ≤ 135.2 mmol/L (1 point), was established. A cut-off value of a total score of 2 points or higher yielded a sensitivity of 87.0% and a specificity of 78.4%, with an area under the curve of 0.891. External validation with clinical diagnostic standard showed that a cut-off value of total score of 2 points or higher for predicting the IVIG-resistance yielded a sensitivity of 70.0% and a specificity of 75.1%. For the first time, we proposed a predictive model of IVIG resistance in KD infants under 1-year old. The scoring system, which accounts for baseline peripheral NLR, MPVLR, and serum albumin and sodium, predicts with relatively high sensitivity and specificity for IVIG-resistant infants with KD under 1-year old.
1岁以下川崎病（KD）患儿发生静脉注射免疫球蛋白（IVIG）抵抗的风险较高。本研究旨在探索1岁以下KD患儿IVIG抵抗的预测指标。本研究纳入了北京大学第一医院和武汉儿童医院的1岁以下KD患儿。所有婴儿被分为IVIG反应型和IVIG抵抗型两组。比较了两组在人口统计学特征、临床特征和实验室检查方面的差异，并分析了IVIG抵抗型KD的危险因素。此外，开发了一种用于预测KD婴儿IVIG抵抗的评分系统，并进行了外部验证。本研究共纳入282例婴儿（194例男孩，中位年龄7.0个月），其中23例为IVIG抵抗型。与IVIG反应型婴儿相比，IVIG抵抗型组婴儿外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积与淋巴细胞比值（MPVLR）较高，IVIG治疗前血清白蛋白和血清钠水平较低（均P<0.01）。多元回归分析表明，外周血NLR和MPVLR水平较高，血清白蛋白和血清钠水平较低是1岁以下KD患儿IVIG抵抗的独立危险因素。建立了一个评分系统，该系统包括外周血NLR≥2.69（1分）、MPVLR≥2.78（1分）、血清白蛋白≤30.7 g/L（1分）和血清钠≤135.2 mmol/L（1分）。总分2分及以上的截断值产生的灵敏度为87.0%，特异度为78.4%，曲线下面积为0.891。采用临床诊断标准进行外部验证表明，预测IVIG抵抗的总分2分及以上的截断值产生的灵敏度为70.0%，特异度为75.1%。我们首次提出了1岁以下KD患儿IVIG抵抗的预测模型。该评分系统考虑了基线外周血NLR、MPVLR以及血清白蛋白和钠水平，对1岁以下KD IVIG抵抗型婴儿具有较高的预测灵敏度和特异度。
