Document Type

Article

Publication Date

5-1-2011

Identifier

PMCID: PMC3075321 DOI: 10.1016/j.jpeds.2010.10.031

Abstract

OBJECTIVES: To assess the performance of 3 risk scores from Japan that were developed to predict, in children with Kawasaki disease, resistance to intravenous immunoglobulin (IVIG) treatment.

STUDY DESIGN: We used data from a randomized trial of pulsed steroids for primary treatment of Kawasaki disease to assess operating characteristics of the 3 risk scores, and we examined whether steroid therapy lowers the risk of coronary artery abnormalities in patients prospectively classified as IVIG resistant.

RESULTS: For comparability with published cohorts, we analyzed the data of 99 patients who were not treated with steroids (16% IVIG-retreated) and identified male sex, lower albumin level, and higher aspartate aminotransferase level as independent risk factors for IVIG resistance. The Kobayashi score was similar in IVIG-resistant and -responsive patients, yielding a sensitivity of 33% and specificity of 87%. There was no interaction of high-risk versus low-risk status by treatment received (steroid versus placebo) with any of the 3 risk score algorithms.

CONCLUSION: Risk-scoring systems from Japan have good specificity but low sensitivity for predicting IVIG resistance in a North American cohort. Primary steroid therapy did not improve coronary outcomes in patients prospectively classified as being at high-risk for IVIG resistance.

Journal Title

The Journal of pediatrics

Volume

158

Issue

5

First Page

831

Last Page

835

MeSH Keywords

Child, Preschool; Double-Blind Method; Drug Resistance; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infant; Infusions, Intravenous; Male; Mucocutaneous Lymph Node Syndrome; Prognosis; ROC Curve; Retrospective Studies; Treatment Outcome

Keywords

Kawasaki Disease

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