Ahmed Nazneen, Pal Priyankar, Azad Syed Md, Ghosh Apurba, Banerjee Paramita, Sarkar Subhajit Dey
Institute of Child Health, 11 Biresh Guha Street, Kolkata, 700017, India.
Pediatric Rheumatology Department, Institute of Child Health, Kolkata, India.
Clin Rheumatol. 2023 Jan;42(1):145-150. doi: 10.1007/s10067-022-06344-3. Epub 2022 Sep 2.
To assess the risk factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) and to evaluate the performance of the three Japanese risk-scoring systems, namely the Kobayashi, Egami, and Sano scores in predicting IVIG resistance among the Indian patients.
Prospective observational study on children admitted with KD at Institute of Child Health, Kolkata, over a period of 16 months, from January 2019 to April 2020. The study included 70 KD patients all of whom were treated with IVIG. Clinical parameters, laboratory variables, and risk scores were compared between the IVIG-responsive and the IVIG-resistant groups.
A total of 31.4% were IVIG non-responders. Skin rash was found to be significantly associated with IVIG-resistant KD. The IVIG-resistant group had higher total bilirubin, lower albumin, higher CRP levels, and higher ALT and AST levels. High Kobayashi score, high Egami score, and high Sano score were significantly associated with IVIG resistance, individually. Sano score had the highest sensitivity (81.8%) and Kobayashi score had the highest specificity (77.1%) in our cohort.
The presence of skin rash, high total bilirubin, high CRP, high AST, high ALT, and low albumin were important predictors of IVIG resistance in our population. Among the three scores, Sano score is the most reliable in identifying potential non-responders to IVIG. But Sano score lacked good specificity. Therefore, Indian KD patients may need an exclusive scoring system to predict non-responsiveness to IVIG so that a more aggressive therapy can be instituted at the earliest. Key points • Early prediction of IVIG-resistant KD is necessary to limit cardiac injuries. • Sano score has high sensitivity to predict IVIG resistance in Indian population.
评估静脉注射免疫球蛋白（IVIG）抵抗型川崎病（KD）的危险因素，并评估三种日本风险评分系统，即小林评分、江上评分和佐野评分在预测印度患者IVIG抵抗方面的表现。
对2019年1月至2020年4月期间在加尔各答儿童健康研究所收治的KD患儿进行了为期16个月的前瞻性观察研究。该研究纳入了70例均接受IVIG治疗的KD患者。比较了IVIG反应型和IVIG抵抗型组之间的临床参数、实验室变量和风险评分。
共有31.4%的患者对IVIG无反应。发现皮疹与IVIG抵抗型KD显著相关。IVIG抵抗型组的总胆红素更高、白蛋白更低、CRP水平更高以及ALT和AST水平更高。单独来看，高小林评分、高江上评分和高佐野评分均与IVIG抵抗显著相关。在我们的队列中，佐野评分的敏感性最高（81.8%），小林评分的特异性最高（77.1%）。
皮疹、高总胆红素、高CRP、高AST、高ALT和低白蛋白的存在是我们研究人群中IVIG抵抗的重要预测因素。在这三种评分中，佐野评分在识别潜在的IVIG无反应者方面最可靠。但佐野评分缺乏良好的特异性。因此，印度KD患者可能需要一个专门的评分系统来预测对IVIG的无反应性，以便尽早实施更积极的治疗。关键点 • 早期预测IVIG抵抗型KD对于限制心脏损伤是必要的。 • 佐野评分在预测印度人群IVIG抵抗方面具有高敏感性。
