Study On The Prediction Of Intravenous Immunoglobulin Nonresponsive Kawasaki Disease

Objective:To analyze the risk factors of intravenous immunoglobulin(IVIG)resistance Kawasaki disease(KD)and establish a logistic regression prediction model to evaluate the possibility of IVIG resistance and improve the diagnostic efficacy of nonresponse to IVIG,so as to provide reference for early diagnosis of suspected KD.Methods:The clinical data of children with KD diagnosed and treated in the First Affiliated Hospital of China Medical University from January 2012 to December 2020were retrospectively analyzed.Objective to analyze the value of age,gender and laboratory examination indexes in the diagnosis of IVIG non response before and after IVIG treatment.Univariate analysis and multivariate logistic regression analysis were used to establish a logistic regression model using spss20.0 software to find the independent risk factors of IVIG non response in children with KD.The critical values of risk factors were assigned to obtain a new scoring system.Results:In the logistic regression model of IVIG nonresponsive Kawasaki disease,age,gender,white blood cell count(WBC),neutrophil count(NE),urine white blood cell(u-leu),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and procalcitonin(PCT)were used as variables.PCT,ESR and u-leu before IVIG treatment and WBC,NE and PCT after IVIG treatment finally entered the logistic regression prediction model.Multivariate logistic regression analysis showed that PCT and ESR before IVIG treatment and WBC,NE and PCT after IVIG treatment were independent risk factors for IVIG nonresponsive KD(all P<0.05);according to the risk degree of each factor,a new simple scoring system was established,before IVIG treatment PCT≥0.5335ng/ml was given 0.5 points,ESR≥57.5mm/h was given 1.5 points,after IVIG treatment WBC≥10.50×10~9/L was given 1.5 points,NE≥5.68×10~9/L was given 1.5points,PCT≥0.155ng/ml was given 2.0 points,with a total of 6.5 points.Taking 2 points as the critical value,area under ROC curve(AUC)was 0.725(95%CI:0.568～0.882),sensitivity was 69.2%,specificity was 69.4%,and Youden index was 0.386.Conclusion:The laboratory indexes within 48 hours after IVIG treatment are more effective in predicting IVIG non response.Combined with the laboratory indexes before IVIG treatment,it can improve the ability of clinical prediction of children with IVIG non response KD,which is expected to provide a theoretical basis for early intervention treatment.