Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
Ital J Pediatr. 2023 Jun 25;49(1):78. doi: 10.1186/s13052-023-01482-z.
Intravenous immunoglobulin (IVIG) has been the mainstay of treatment for Kawasaki disease (KD) over the past decades. However, 10-20% of KD patients are resistant to IVIG treatment which puts those patients at high risk of coronary artery lesions (CALs). Therefore, it is important to predict whether patients will be resistant to IVIG before the treatment. This study aimed to investigate the risk factors for IVIG non-responsive patients with KD.
This study enrolled patients diagnosed with KD and divided them into two groups, IVIG responders and IVIG non-responders. We compared the differences in demographics and clinical data between the two groups. Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis.
In total, 907 KD patients were reviewed, with 841 IVIG responders and 66 IVIG non-responders. Patients in IVIG responders were younger than IVIG non-responders. The length of hospitalization of the IVIG non-responders was significantly longer than IVIG responders. The neutrophils%, C-reaction protein (CRP), and CRP/albumin ratio in IVIG responders were significantly lower than in IVIG non-responders (P < 0.05). The lymphocyte% and Albumin in IVIG responders were significantly higher than in IVIG non-responders. Multivariable logistic regression analysis demonstrated that albumin (OR = 0.881, 95% CI, 0.781 to 0.994, p-value = 0.039) was an independent risk factor for predicting IVIG resistance. The area under the ROC curve was 0.644, with a cut-off of ≤ 33.4 g/L determined by Youden's index. The sensitivity and specificity in predicting IVIG resistance were 40.91% and 83.47%, respectively.
Albumin can serve as a potential predicting marker for IVIG resistance in KD. A lower albumin level may be useful for identifying KD patients with a high risk of IVIG resistance to guide further therapy strategies.
静脉注射免疫球蛋白（IVIG）在过去几十年一直是川崎病（KD）的主要治疗方法。然而，10-20%的 KD 患者对 IVIG 治疗无反应，这使这些患者发生冠状动脉损伤（CAL）的风险很高。因此，在治疗前预测患者是否对 IVIG 无反应非常重要。本研究旨在探讨 KD 患者对 IVIG 无反应的危险因素。
本研究纳入了诊断为 KD 的患者，并将其分为两组，即 IVIG 反应者和 IVIG 无反应者。我们比较了两组患者在人口统计学和临床数据方面的差异。采用方差分析和卡方检验进行组间差异分析。采用多因素 logistic 回归分析和受试者工作特征（ROC）曲线分析确定 IVIG 抵抗的预测因素。
共回顾性分析了 907 例 KD 患者，其中 841 例 IVIG 反应者和 66 例 IVIG 无反应者。IVIG 反应者的年龄小于 IVIG 无反应者。IVIG 无反应者的住院时间明显长于 IVIG 反应者。IVIG 反应者的中性粒细胞%、C 反应蛋白（CRP）和 CRP/白蛋白比值明显低于 IVIG 无反应者（P<0.05）。IVIG 反应者的淋巴细胞%和白蛋白明显高于 IVIG 无反应者。多因素 logistic 回归分析表明，白蛋白（OR=0.881，95%CI，0.781 至 0.994，p 值=0.039）是预测 IVIG 抵抗的独立危险因素。ROC 曲线下面积为 0.644，通过 Youden 指数确定截断值为≤33.4 g/L。预测 IVIG 抵抗的敏感性和特异性分别为 40.91%和 83.47%。
白蛋白可作为 KD 患者对 IVIG 抵抗的潜在预测标志物。较低的白蛋白水平可能有助于识别 KD 患者对 IVIG 抵抗的高风险，以指导进一步的治疗策略。
