Clinical Characteristics Of Incomplete Kawasaki Disease And Risk Factors Of IVIG Non-response Kawasaki Disease In Fuyang Area

Objective: To study the clinical characteristics of children with incomplete Kawasaki disease(IKD)and intravenous immunoglobulin(IVIG)non-response Kawasaki disease,ⅰ).analyze the risk factors of IVIG non-response KD,ⅱ).evaluate the predictive efficiency of different scoring systems on IVIG non-response KD in this region,ⅲ).find a predictive scoring system suitable for this region.Methods The clinical data of 298 children who met the diagnostic criteria of KD were collected from Fuyang People’s Hospital from January 2017 to June 2022.According to the diagnostic criteria of Kawasaki disease,it was divided into two groups: complete Kawasaki disease(CKD)and incomplete Kawasaki disease;According to the therapeutic effect of IVIG,they were divided into IVIG sensitive KD group and IVIG non-response KD group.The differences in clinical manifestation,laboratory indexes,coronary artery dilation and treatment effect between IKD and CKD,IVIG non-response KD and IVIG sensitive KD were analyzed retrospectively.The independent risk factors of IVIG non-response KD were screened by single factor and multivariate logistic regression analysis and ROC curve,and the Kobayashi score,Egami score,Sano score,Fu score were evaluated Predicted energy efficiency of Formosa score and Xiao score system.Results:(1)Of the 298 children with KD,176 were male and 122 were female,with a ratio of 1.44:1.The age of onset is concentrated in the age group from June to 5 years old(83%),with the minimum age of onset being 2 months and the maximum age being6 years old.There were 83 cases of IKD,with an incidence of 27.9%;There were 42 cases of IVIG unresponsive KD,with an incidence of 14.1%.(2)Compared with CKD group,the fever time of children in IKD group was significantly prolonged,the treatment time of the first dose of IVIG was delayed,the number of typical clinical manifestations was significantly reduced,and the laboratory indicators showed that the hemoglobin level and the percentage of neutrophils were significantly decreased(P<0.05).(3)Compared with IVIG reactive KD,the fever time of IVIG non-response KD children was significantly prolonged,the first dose of IVIG treatment was earlier,the incidence of perianal changes was higher,the levels of NEU%,HB,ALT,AST,TB were higher,and the level of PLT was lower(P<0.05).(4)The univariate analysis of IVIG non-response KD showed that the duration of fever,the treatment time of the first dose of IVIG,perianal changes,NEU%,PLT,ALT,AST and TB indicators were related to the occurrence of IVIG non-response;Multivariate analysis showed that the duration of fever and the treatment time of the first dose of IVIG were independent risk factors for IVIG non-response KD.(5)Among the six scoring systems,the Kobayashi scoring system has the largest area under the ROC curve.The correct rate of predicting IVIG non-response KD in this study is the highest(positive predictive value is 69%),the sensitivity is 69%,the specificity is 66.5%,and the Yoden index is 0.335.Conclusion: The incidence of KD is more common in men and 6-5 years old;Children with IKD have longer fever than those with CKD,and the typical clinical features are rare.The treatment time of the first dose of IVIG is delayed,and the degree of anemia is severe;The fever time of IVIG non-response KD is longer than that of IVIG sensitive KD.The first dose of IVIG is earlier than that of the latter.The levels of NEU%,HB,ALT,AST and TB of the former are higher than that of the latter,while the level of PLT of the former is lower than that of the latter;The duration of fever and the treatment time of the first dose of IVIG are independent risk factors of IVIG non-response KD;Among the six scoring systems,Kobayashi scoring system has the best prediction efficiency.