Analysis Of Risk Factors And Discussion Of Risk Scoring System Of Intravenous Immunoglobulin-resistant Kawasaki Disease In Southern Sichuan

Objective:To evaluate the predictive efficacy of domestic and international scoring systems and analyze the risk factors and construct a risk scoring system for intravenous immunoglobulin(IVIG)resistance in patients with Kawasaki disease(KD)in Southern Sichuan,China.Methods:Clinical data of 987 KD patients who were treated from Southern Sichuan were retrospectively analyzed.These children were divided into two groups to their reaction to the treatment of IVIG: sensitive group(877 cases)and no-response group(110 cases).The scoring systems of Shanghai,Chongqing,Beijing,Suzhou and Japan were applied to all patients.Risk factors of IVIG non-responsive KD in Southern Sichuan were investigated by using univariate analysis and multivariate logistic regression models,and then assigned the value of each risk factor to get the scoring system in Southen Sichuan.Results: The sensitivity of the scoring system in Shanghai,Beijing,Suzhou,Chongqing and Japan were 75.5%?40%?23.6%?33.6%?21.8%?25.5%,respectively,and the specificity were 40.5%?90.7%?88.1%?85.2%?84.4%?88.5%,respectively.In our study,univariate analysis showed that rash,extremity changes,hematocrit(HCT),total bilirubin(TB),percentage of lymphocyte(L-R),hemoglobin(HGB),C-reactive protein(CRP),percentage of neutrophil(N-R),neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)were related to IVIG unresponsiveness,while HGB?108g/L,TB>9.6?mol/L,NLR>3.98 and rash were identifid as risk factors of IVIG unresponsiveness by multivariate logistic analysis.A new scoring system was constructed by four predictors:HGB?108g/L(score of 2.5);NLR>3.98(score of 2.5);TB>9.6?mol/L(score of 1.5);rash(score of 1.5).When the total score is?5,the sensitivity is 57.3% and the specificity is 75.3%.Conclusion:The six of scoring systems were efficient in predicting IVIG unresponsiveness in KD in Southern Sichuan and not suitable for all regions of China.HGB?108g/L,TB>9.6?mol/L,NLR >3.98 and rash were the best independent risk factors of IVIG unresponsiveness in KD.The new scoring system has a low sensitivity,and its predicting efficiency is not optimal enough.