A New Scoring System to Predict Intravenous Immunoglobulin Unresponsiveness in Patietns

1321 poster, cat 49

A NEW SCORING SYSTEM TO PREDICT INTRAVENOUS IMMUNOGLOBULIN UNRESPONSIVENESS IN PATIENTS WITH

KAWASAKI DISEASE

S. Shimoyama1, Tohru Kobayashi1, Y. Inoue1, K. Takeuchi2, Tomio Kobayashi3,

Y. Okada1, K. Tamura1, T. Tomomasa1, T. Otani1, H. Arakawa1, A. Morikawa1

1Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan, 2Saitama University, Saitama, Saitama, Japan, 3Gunma Children's Medical School, Shibukawa, Gunma, Japan

Objectives: The objective of this study was to find the predictors and generate a new scoring model to predict intravenous immunoglobulin (IVIG) unresponsiveness in patients with Kawasaki disease (KD).Background: Advance identification of likely IVIG unresponsiveness among KD patients has been important but difficult.

Methods and Results: We reviewed clinical records of 750 consecutive KD patients (development dataset) who were received 1g/kg IVIG for 2 consecutive days and 229 subsequent KD patients (validation dataset) who were received 2g/kg IVIG for a day. IVIG unresponsiveness was defined by fever persisting beyond 24 hr, or recrudescent fever associated with KD symptoms after an afebrile period. Using the logistic regression analysis, seven variables were used to generate a simple scoring model. Cutoff points and weighted scores for each variable were; 2 points each for aspartate aminotransferase >=100 IU/L, sodium <=133 mmol/L, neutrophil count >=80% of white cells, and days of illness at initial treatment <=4; and 1 point each for age <=12 months, C-reactive protein >=10 mg/dL, and platelet count <=300,000 /mm3. An area under the receiver-operating-characteristics curve was 0.85 and 0.79 for the development and validation datasets, respectively. For a cutoff of 5 points or more in the scoring model, sensitivity and specificity were 76% and 80% in the developmental dataset; and 67% and 83% in the validation dataset.

Conclusions: Our new scoring model showed high sensitivity and specificity, in identifying IVIG unresponsiveness among KD patients. This model should prove valuable for decision-making concerning initial treatment in patients with KD.