Abstract:

Objective To evaluate the predictive efficiency of 4 different scoring systems and investigate the risk factors of intravenous immunoglobulin (IVIG) unresponsiveness in Kawasaki disease (KD) patients in Southwest China. Methods Clinical data of 140 IVIG unresponsive KD patients and 140 randomly sampled IVIG responsive ones were retrospectively analyzed. Kobayashi, Egami, Sano and Fu scoring systems were applied to all patients. Risk factors of IVIG unresponsiveness in KD were investigated by using univariate analysis and multivariate logistic regression models. Results The Youden indexes of all these 4 scoring systems in the study were from 0.164 to 0.286. In our study, univariate analysis showed that cervical lymphadenopathy, polymorphous exanthema, platelet count (PLT), percentage of neutrophil (N%)，C-reactive protein (CRP), total bilirubin (TB) and albumin (ALB) were related to IVIG unresponsiveness, while polymorphous exanthema，PLT and CRP were identified as risk factors of IVIG unresponsiveness by using multivariate logistic analysis (P<0.05). A new scoring system was constructed by three predictors: polymorphous exanthema (score of 2), PLT≤280×109·L-1 (score of 1) and CRP≥60 mg·L-1 (score of 1). The incidence of IVIG unresponsiveness would be high if score of ≥3. The sensitivity was 70% and the specificity was 60%. Conclusion The Youden indexes of these 4 scoring systems were not more than 0.286, which indicated that none of these 4 scoring systems was efficient in predicting IVIG unresponsiveness in KD and not suitable for Chinese children. In this study, the predicting efficiency of the new scoring system was not optimal enough，as it had a higher sensitivity but a relatively low specificity.