Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2021 Oct;120(10):1884-1889. doi: 10.1016/j.jfma.2020.12.010. Epub 2020 Dec 23.
BACKGROUND/PURPOSE: Kawasaki disease (KD) is the most common type of acquired heart disease in children, and intravenous immunoglobulin (IVIG) therapy is the preferred treatment. Several risk scoring systems have been developed to predict IVIG resistance, which is important in KD management, including the Kobayashi, Egami, and Formosa scores. We evaluated the performance of these scoring systems with a KD patient cohort from Taiwan.
We retrospectively analyzed the medical records of all KD patients admitted to our institution from 2012 to 2017. We compared the characteristics of IVIG-resistant and non-resistant patients and evaluated the predictive ability of the scoring systems for IVIG resistance.
We included 84 patients, with 73 receiving IVIG therapy. Eight patients were unresponsive to the first IVIG course. Compared to those with good response to therapy or spontaneous improvement, IVIG-resistant patients had a higher C-reactive protein level (16.1 mg/dL vs. 8.6 mg/dL, p < 0.001), higher percentage of segmented leukocytes (75.7% vs. 61.7%, p = 0.008), and lower albumin level (2.98 mg/dL vs. 3.78 mg/dL, p = 0.001). In determining IVIG resistance, the sensitivity and specificity varied among scoring systems (Kobayashi, 37.5% and 86.8%; Egami, 37.5% and 84.2%; and Formosa, 87.5% and 73.7%, respectively). The positive and negative predictive values of the Formosa score were 25.9% and 98.2%, respectively.
The Formosa score had the highest sensitivity in determining IVIG resistance. Although the positive predictive value was low, the negative predictive value could reach 98.2%. The Formosa score was superior to other scoring systems in predicting IVIG resistance in Taiwanese KD patients.
背景/目的：川崎病（KD）是儿童最常见的后天性心脏病，静脉注射免疫球蛋白（IVIG）治疗是首选治疗方法。已经开发了几种风险评分系统来预测 IVIG 抵抗，这在 KD 管理中很重要，包括小林、江田和福尔摩沙评分。我们用来自台湾的 KD 患者队列评估了这些评分系统的性能。
我们回顾性分析了 2012 年至 2017 年期间我院收治的所有 KD 患者的病历。我们比较了 IVIG 抵抗和非抵抗患者的特征，并评估了评分系统对 IVIG 抵抗的预测能力。
我们纳入了 84 例患者，其中 73 例接受了 IVIG 治疗。8 例患者对首次 IVIG 疗程无反应。与治疗反应良好或自发改善的患者相比，IVIG 抵抗患者的 C 反应蛋白水平更高（16.1mg/dL 比 8.6mg/dL，p<0.001），白细胞分类计数中淋巴细胞比例更高（75.7%比 61.7%，p=0.008），白蛋白水平更低（2.98mg/dL 比 3.78mg/dL，p=0.001）。在确定 IVIG 抵抗方面，评分系统的敏感性和特异性不同（小林氏评分分别为 37.5%和 86.8%；江田氏评分分别为 37.5%和 84.2%；福尔摩沙评分分别为 87.5%和 73.7%）。福尔摩沙评分的阳性和阴性预测值分别为 25.9%和 98.2%。
福尔摩沙评分在确定 IVIG 抵抗方面具有最高的敏感性。尽管阳性预测值较低，但阴性预测值可达 98.2%。在预测台湾 KD 患者的 IVIG 抵抗方面，福尔摩沙评分优于其他评分系统。
