From the Department of Pediatrics, Aichi Medical University, Aichi, Japan.
Pediatr Infect Dis J. 2020 Sep;39(9):857-861. doi: 10.1097/INF.0000000000002716.
To investigate the usefulness of procalcitonin (PCT) as predictive factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease patients.
We retrospectively analyzed the laboratory data from 215 children with Kawasaki disease treated with IVIG from 2014 to 2019. We analyzed the clinical and laboratory parameters just before the IVIG including serum levels of PCT with respect to the IVIG response.
Eventually, 127 patients were analyzed. The median age was 2.4 years. IVIG was effective in 108 children (responders) and was ineffective in 19 (non-responders). Serum PCT concentration was higher in non-responders than those of responders (P < 0.001). Multivariate logistic regression analyses indicated that higher PCT concentration (odds ratio 1.34, 95% confidence interval 1.10-1.64) were associated with IVIG resistance. Analyses of the receiver operating characteristic curve showed that the cutoff value of PCT 2.18 ng/mL had 46.4% of sensitivity and 93.9% of specificity. Receiver operating characteristic analysis yielded an area under the curve of 0.82 (0.72-0.92) to predict IVIG resistance.
Serum PCT value can be an excellent biomarker for predicting unresponsiveness to IVIG with a good discriminatory ability as well as the existing prediction scores.
探讨降钙素原（PCT）作为预测静脉注射免疫球蛋白（IVIG）抵抗川崎病患者的有用指标。
我们回顾性分析了 2014 年至 2019 年间 215 例接受 IVIG 治疗的川崎病患儿的实验室数据。我们分析了 IVIG 前的临床和实验室参数，包括 PCT 血清水平与 IVIG 反应的关系。
最终分析了 127 例患儿。中位年龄为 2.4 岁。IVIG 对 108 例患儿（有效组）有效，对 19 例患儿（无效组）无效。无效组患儿 PCT 浓度高于有效组（P < 0.001）。多变量逻辑回归分析表明，较高的 PCT 浓度（比值比 1.34，95%置信区间 1.10-1.64）与 IVIG 抵抗相关。受试者工作特征曲线分析显示，PCT 截断值 2.18 ng/mL 的敏感性为 46.4%，特异性为 93.9%。受试者工作特征分析得出，预测 IVIG 抵抗的曲线下面积为 0.82（0.72-0.92）。
血清 PCT 值可以作为预测 IVIG 无反应性的一个极好的生物标志物，具有良好的鉴别能力以及现有的预测评分。
