评估 egami、小林和佐野评分在预测婴儿川崎病 IVIG 抵抗中的表现。
Evaluating the performance of egami, kobayashi and sano scores in predicting IVIG resistance in infant kawasaki disease.
机构信息
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Division of Pediatric Cardiology, Kyungpook National University Children's Hospital, Daegu, Republic of Korea.
出版信息
BMC Pediatr. 2024 Sep 28;24(1):606. doi: 10.1186/s12887-024-05035-z.
BACKGROUND
This study aimed to evaluate the effectiveness of Egami, Kobayashi and Sano scores in predicting intravenous immunoglobulin (IVIG) resistance in infant Kawasaki disease (KD), considering its unique clinical presentation.
METHODS
We retrospectively analysed 143 infants aged < 12 months and diagnosed with KD at a single centre from 2019 to 2023. Patients were divided into IVIG-resistant and IVIG-responsive groups. Demographic, clinical and laboratory data were compared between the groups. The diagnostic performance of Egami, Kobayashi and Sano scores in predicting IVIG resistance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). Additionally, we developed a new scoring system based on significant predictors identified in our cohort.
RESULTS
Among 143 infants, 45 (31.5%) showed IVIG resistance. The IVIG-resistant group had a significantly higher rate of coronary artery lesions (15.6% vs. 5.1%, p = 0.036). Incomplete KD was observed in 61.5% of cases. Egami, Kobayashi and Sano scores exhibited low sensitivity (35.6%, 55.6% and 20%, respectively) and moderate specificity (77.6%, 63.3% and 95.9%, respectively) in predicting IVIG resistance. The AUC ranged from 0.583 to 0.674, indicating poor to fair discriminative ability. Our newly developed scoring system, based on total bilirubin and albumin levels, showed similar performance (AUC 0.633) to existing scores.
CONCLUSIONS
Existing Japanese risk scoring systems and our newly developed score showed limited effectiveness in predicting IVIG resistance in infant KD. The high proportion of incomplete presentation and IVIG resistance in infants highlights the need for age-specific risk assessment and management. Further research is necessary to develop more sophisticated, dedicated prediction model for IVIG resistance in infants with KD.
背景
本研究旨在评估 Egami、Kobayashi 和 Sano 评分在预测婴儿川崎病（KD）静脉注射免疫球蛋白（IVIG）抵抗方面的有效性，同时考虑到其独特的临床表现。
方法
我们回顾性分析了 2019 年至 2023 年在单一中心诊断为 KD 的 143 名年龄<12 个月的婴儿。患者分为 IVIG 抵抗组和 IVIG 反应组。比较两组的人口统计学、临床和实验室数据。使用敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征曲线下面积（AUC）评估 Egami、Kobayashi 和 Sano 评分预测 IVIG 抵抗的诊断性能。此外，我们根据本队列中确定的显著预测因素开发了一种新的评分系统。
结果
在 143 名婴儿中，45 名（31.5%）出现 IVIG 抵抗。IVIG 抵抗组的冠状动脉损伤发生率明显更高（15.6%比 5.1%，p=0.036）。不完全性 KD 占 61.5%。Egami、Kobayashi 和 Sano 评分预测 IVIG 抵抗的敏感性分别为 35.6%、55.6%和 20%，特异性分别为 77.6%、63.3%和 95.9%，表明诊断效能较低。AUC 范围为 0.583 至 0.674，表明具有较差至中等的区分能力。我们基于总胆红素和白蛋白水平开发的新评分系统与现有评分系统具有相似的性能（AUC 为 0.633）。
结论
现有的日本风险评分系统和我们新开发的评分系统在预测婴儿 KD 的 IVIG 抵抗方面效果有限。婴儿中不完全表现和 IVIG 抵抗的高比例突出表明需要进行年龄特异性风险评估和管理。需要进一步研究以开发更复杂、专门针对婴儿 KD 中 IVIG 抵抗的预测模型。
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