A novel model for predicting intravenous immunoglobulin-resistance in Kawasaki disease: a large cohort study

Shuhui Wang; Chuxin Ding; Qiyue Zhang; Miao Hou; Ye Chen; Hongbiao Huang; Guanghui Qian; Daoping Yang; Changqing Tang; Yiming Zheng; Li Huang; Lei Xu; Jiaying Zhang; Yang Gao; Wenyu Zhuo; Bihe Zeng; Haitao Lv

doi:10.3389/fcvm.2023.1226592

A novel model for predicting intravenous immunoglobulin-resistance in Kawasaki disease: a large cohort study

Front Cardiovasc Med. 2023 Jul 28:10:1226592. doi: 10.3389/fcvm.2023.1226592. eCollection 2023.

Authors

Shuhui Wang^{1

2}, Chuxin Ding¹, Qiyue Zhang¹, Miao Hou¹, Ye Chen¹, Hongbiao Huang², Guanghui Qian², Daoping Yang¹, Changqing Tang¹, Yiming Zheng², Li Huang², Lei Xu², Jiaying Zhang², Yang Gao¹, Wenyu Zhuo², Bihe Zeng², Haitao Lv^{1

2}

Affiliations

¹ Department of Cardiology, Children's Hospital of Soochow University, Suzhou, China.
² Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.

Abstract

Background: Predicting intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) can aid early treatment and prevent coronary artery lesions. A clinically consistent predictive model was developed for IVIG resistance in KD.

Methods: In this retrospective cohort study of children diagnosed with KD from January 1, 2016 to December 31, 2021, a scoring system was constructed. A prospective model validation was performed using the dataset of children with KD diagnosed from January 1 to June 2022. The least absolute shrinkage and selection operator (LASSO) regression analysis optimally selected baseline variables. Multivariate logistic regression incorporated predictors from the LASSO regression analysis to construct the model. Using selected variables, a nomogram was developed. The calibration plot, area under the receiver operating characteristic curve (AUC), and clinical impact curve (CIC) were used to evaluate model performance.

Results: Of 1975, 1,259 children (1,177 IVIG-sensitive and 82 IVIG-resistant KD) were included in the training set. Lymphocyte percentage; C-reactive protein/albumin ratio (CAR); and aspartate aminotransferase, sodium, and total bilirubin levels, were risk factors for IVIG resistance. The training set AUC was 0.825 (sensitivity, 0.723; specificity, 0.744). CIC indicated good clinical application of the nomogram.

Conclusion: The nomogram can well predict IVIG resistance in KD. CAR was an important marker in predicting IVIG resistance in Kawasaki disease.

Keywords: C-reactive protein to albumin ratio (CAR); Kawasaki disease; children; intravenous immunoglobulin resistance; prediction model.

Grants and funding

This work was supported by the National Natural Science Foundation of China [grant numbers 82070512, 82270529, 82171797], Postgraduate Research & Practice Innovation Program of Jiangsu Province [SJCX23_1668], Suzhou cardiovascular precision diagnosis andtreatment clinical expert team introduction project (SZYJTD201805). Key research and development Program of Science and Technology Department of Jiangsu Province (BE2021655).