Role Of Different Scoring Systems In Predicting Intravenous Immunoglobulin Unresponsiveness In Kawasaki Disease

ObjectiveTo evaluate the predictive efficiency of 4 different scoring systems and investigate risk factors of intravenous immunoglobulin(IVIG)unresponsiveness in Kawasaki disease(KD) patients in Southwest China.MethodsClinical 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.ResultsThe Youden indexes(Youden index=sensitivity + specificity-1) of all these 4 scoring systems in our research 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), albumin(ALB) wererelated 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), which yielded an area under the receiver-operating-characteristics curve of 0.747. A new scoring system was constructed by three predictors: polymorphous exanthema(score of 2),PLT≤280×109/L(score of 1) and CRP≥60mg/L(score of 1). The incidence of IVIG unresponsiveness would be high if score of ≥3. The sensitivity was70% and the specificity was 60%.ConclusionThe Youden indexes of all these 4 scoring systems were not more than0.286, 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.