Department of Pediatrics, UNLV School of Medicine, Las Vegas, NV, USA.
Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
Pediatr Cardiol. 2023 Oct;44(7):1546-1551. doi: 10.1007/s00246-023-03175-0. Epub 2023 May 12.
To evaluate existing scoring systems and develop a new model to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). A retrospective cohort study performed between 2004 and 2017 identified 115 patients treated with IVIG for classic or incomplete KD. In our practice, IVIG resistance was defined as fever for > 24 h and patients were divided into responders and non-responders. A univariate analysis was performed to identify independent predictors of IVIG resistance. The predictors were combined into a new scoring system and compared with existing scoring systems. Sixty-five patients had classic KD and 50 had incomplete KD. Among the 115 patients, 80 (69.6%) responded and the remaining 35 were resistant (30.4%) to IVIG. Of the 35 resistant patients, 16 patients had incomplete KD. Hispanic children comprised 43% of our sample population. Coronary artery abnormalities developed in 14 of the 35 IVIG-resistant patients (39%). Univariate analysis showed that IVIG-resistant patients were older and present with lower platelets, potassium, and creatinine (P < 0.05). Multivariate logistic regression analysis used platelets, potassium, body surface area (BSA), and creatinine to devise the Las Vegas Scoring System (LVSS), which demonstrated a sensitivity of 76.2% and a specificity of 68.6%. Compared to published data, we observed a higher rate of IVIG resistance and coronary artery abnormalities in our patient population. The LVSS (using platelets, potassium, BSA, and creatinine) showed higher specificity and comparable sensitivity to other scoring systems devised to predict IVIG resistance.
评估现有的评分系统，并开发一种新的模型来预测川崎病（KD）患者静脉注射免疫球蛋白（IVIG）的耐药性。本研究回顾性地纳入了 2004 年至 2017 年间接受 IVIG 治疗的 115 例经典或不典型 KD 患者。在我们的实践中，将 IVIG 耐药定义为发热持续时间超过 24 小时，根据发热持续时间将患者分为有反应者和无反应者。对所有患者进行单因素分析以识别 IVIG 耐药的独立预测因素。将预测因素组合成一个新的评分系统，并与现有的评分系统进行比较。在 115 例患者中，65 例为经典 KD，50 例为不典型 KD。115 例患者中，80 例（69.6%）对 IVIG 有反应，35 例（30.4%）耐药。在 35 例耐药患者中，16 例为不典型 KD。我们的样本人群中，西班牙裔儿童占 43%。在 35 例 IVIG 耐药患者中，有 14 例（39%）出现冠状动脉异常。单因素分析显示，IVIG 耐药患者年龄较大，血小板、钾、肌酐较低（P<0.05）。多元逻辑回归分析使用血小板、钾、体表面积（BSA）和肌酐来设计拉斯维加斯评分系统（LVSS），该系统的敏感性为 76.2%，特异性为 68.6%。与已发表的数据相比，我们观察到患者人群中 IVIG 耐药和冠状动脉异常的发生率更高。LVSS（使用血小板、钾、BSA 和肌酐）的特异性更高，预测 IVIG 耐药的敏感性与其他评分系统相当。
