A Nomogram Model Identifies Eosinophilic Frequencies to Powerfully Discriminate Kawasaki Disease From Febrile Infections

Abstract

Background: Kawasaki disease (KD) is a form of systemic vasculitis that occurs primarily in children under the age of 5 years old. No single laboratory data can currently distinguish KD from other febrile infection diseases. The purpose of this study was to establish a laboratory data model that can differentiate between KD and other febrile diseases caused by an infection in order to prevent coronary artery complications in KD.Methods: This study consisted of a total of 800 children (249 KD and 551 age- and gender-matched non-KD febrile infection illness) as a case-control study. Laboratory findings were analyzed using univariable, multivariable logistic regression, and nomogram models.Results: We selected 562 children at random as the model group and 238 as the validation group. The predictive nomogram included high eosinophil percentage (100 points), high C-reactive protein (93 points), high alanine transaminase (84 points), low albumin (79 points), and high white blood cell (64 points), which generated an area under the curve of 0.873 for the model group and 0.905 for the validation group. Eosinophilia showed the highest OR: 5.015 (95% CI:−3.068–8.197) during multiple logistic regression. The sensitivity and specificity in the validation group were 84.1 and 86%, respectively. The calibration curves of the validation group for the probability of KD showed near an agreement to the actual probability.Conclusion: Eosinophilia is a major factor in this nomogram model and had high precision for predicting KD. This report is the first among the existing literature to demonstrate the important role of eosinophil in KD by nomogram.

An AI-guided signature reveals the nature of the shared proximal pathways of host immune response in MIS-C and Kawasaki disease

“…Eosinopenia appears to be a notable shared feature between MIS-C and COVID-19 52 , but not KD. These findings are consistent with the fact that KD is known to present with higher (not lower) eosinophil counts, Th2 cytokines IL-4, IL-5, and eosinophil cationic protein (ECP) [53][54][55][56][57] . As in the case of thrombocytopenia, persistent eosinopenia after admission correlated with COVID-19 severity and low rates of recovery 58 .…”

Combination of Hemoglobin-for-Age Z-Score and Plasma Hepcidin Identified as a Novel Predictor for Kawasaki Disease

“…Other groups have also developed laboratory-only diagnostic models for KD, with a sensitivity and specificity of around 75–85% and 60–81%, respectively [ 16 , 59 , 60 ]. Our previous findings also showed that eosinophilia would be a vital predictive factor for patients with KD [ 33 , 61 ] and was associated with the failure of IVIG administration and coronary arterial formation [ 38 , 62 ]. Meanwhile, it was shown that higher procalcitonin levels occur in KD than in COVID-19 children [ 63 ] and septic children [ 18 ].…”

Near Infrared Spectroscopy Detects Change of Tissue Hemoglobin and Water Levelsin Kawasaki Disease and Coronary Artery Lesions

“…Chen et al reported that sonographic gallbladder abnormalities were associated with higher C-reactive protein, GPT, neutrophil, and IVIG resistance in KD [15]. Liu et al reported that alanine transaminase (GPT) was a major factor in the nomogram model and had high precision for distinguishing KD from fever controls [16]. The aminotransferase (AST)/ALT ratio and ALT levels in KD were reported to be significantly associated with disease severity, IVIG resistance, and CAL formation [17,18].…”