Risk Factors for Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Abnormalities in a Chinese Pediatric Population With Kawasaki Disease: A Retrospective Cohort Study

Abstract

BackgroundThe factors predicting high-risk Kawasaki disease (KD) remain unclear. Therefore, we aimed to determine the risk factors for resistance to intravenous immunoglobulin (IVIG) treatment and coronary artery aneurysm (CAA) development in a Chinese pediatric population with high-risk KD.MethodsWe compared the performances of 11 scoring systems that have been reported to predict IVIG resistance among patients with KD hospitalized from January 2013 through August 2021. Patients were risk-stratified based on the optimal scoring system. The association of baseline characteristics with IVIG treatment resistance and CAA development was investigated within the high-risk group of KD.ResultsIn total, 346 pediatric patients with KD were included, of whom 63 (18.2%) presented with IVIG resistance. The Kobayashi score and five Chinese scoring system scores (Tang et al., Yang et al., Lan et al., Liping et al., and Wu et al.) were significantly higher in the IVIG non-responsive KD group than in the IVIG responsive KD group, and the results of the receiver operating characteristic (ROC) curves analysis were observed to be highest in the Xie Liping scoring system for IVIG resistance (area under the curve, 0.650). Especially, 87 (25.1%) patients comprised the high-risk KD group based on this optimal scoring system (≥5 points). IVIG resistance was significantly associated with the total bilirubin-to-albumin ratio (B/A ratio) [odds ratio, 7.427; 95% confidence interval (CI): 1.022–53.951]. The area under the ROC was 0.703 (95% CI: 0.586–0.821), and the cutoff point was 0.383, which indicated a sensitivity and specificity for predicting treatment resistance of 58% and 80%, respectively. The serum albumin level (odds ratio, 1.401; 95% CI: 1.049–1.869) and Z score of the left main coronary artery (odds ratio, 9.023; 95% CI: 1.070–76.112) were independent predictors of CAA development.ConclusionsIn the Chinese pediatric population with KD, the Xie Liping scoring system is the most appropriate method for identifying high-risk patients, and IVIG resistance could be predicted based on the B/A ratio. Serum albumin level and Z score of the left main coronary artery at baseline were warning indicators for CAA development. More intensified or adjunctive therapies and close follow-up should be considered for high-risk patients with these risk factors.

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

“…In our previous work, we found that the B/A ratio was highly associated with IVIG resistance in high-risk patients, with a Xie Liping risk score of ≥5 points; the same results were observed in high-risk patients with KD as defined by a Kobayashi score of ≥4 points [33]. Based on the findings of previous studies [34][35][36], hepatic dysfunction is a common complication during acute KD episodes and is characterized by elevated serum liver enzymes, hypoalbuminemia, and hyperbilirubinemia.…”

Neutrophil to Lymphocyte Ratio as a Biomarker for Predicting the Coronary Artery Abnormality in Kawasaki Disease: A Meta-Analysis

“…A total of six studies [ 15 , 19 – 21 , 27 , 28 ] with 1916 KD patients, of whom 180 developed coronary artery aneurysm, were included in this meta-analysis. The heterogeneity tests showed the extinction of significant heterogeneity ( I 2 = 99.3%; P < 0.001), so the random-effect model was used.…”

“…All the selected studies were published from 2015 to 2021. Of 17 articles, seven came from China [21,22,24,[26][27][28][29], four from Korea [16,19,20,25], three from Turkey [13,17,18], one from Japan [23], one from Taiwan [14], and one from Thailand [15]. Sixteen studies were retrospective [13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29], and one study was prospective [24].…”

“…Of 17 articles, seven came from China [21,22,24,[26][27][28][29], four from Korea [16,19,20,25], three from Turkey [13,17,18], one from Japan [23], one from Taiwan [14], and one from Thailand [15]. Sixteen studies were retrospective [13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29], and one study was prospective [24]. Twelve studies were written in English [13][14][15][16][17][19][20][21][22][23][24][25], one in Turkish [18], and two studies in Chinese [26,29].…”

“…Finally, 17 articles with 6334 KD patients, of whom 1328 developed CAA, were enrolled in this meta-analysis [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The list of included studies is shown in supplementary file B.…”