PMCID: PMC3075321 DOI: 10.1016/j.jpeds.2010.10.031
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.
The Journal of pediatrics
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
Sleeper, Lynn A.; Minich, L Luann; McCrindle, Brian M.; Li, Jennifer S.; Mason, Wilbert; Colan, Steven D.; Atz, Andrew M.; Printz, Beth F.; Baker, Annette; Vetter, Victoria L.; Newburger, Jane W.; Pediatric Heart Network Investigators; and Shirali, Girish S., "Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance." (2011). Manuscripts, Articles, Book Chapters and Other Papers. 927.