External validation of a risk score to predict intravenous immunoglobulin resistance in patients with Kawasaki disease

  • Tohru Kobayashi, Gunma University Graduate School of Medicine, Japan
  • Tomio Kobayashi, Gunma Children's Medical Center, Japan
  • Akihiro Morikawa, Gunma University Graduate School of Medicine, Japan
  • Tstsuya Otani, National Research Institute for Child Health and Development, Japan
  • Mitsuru Seki, Gunma University Graduate School of Medicine, Japan
  • Keiji Tsuchiya, Japan Red Cross Medical Center, Japan
  • Tomohiro Takeda, Japan Red Cross Medical Center, Japan
  • Hirokazu Arakawa, Gunma University Graduate School of Medicine, Japan

    • Background: We previously reported a simple risk score to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) before initiation of treatment. However, the IVIG dosage used in this study (1 g/kg/day for each of 2 days) differs from the single infusion of 2 g/kg. Our aim was to assess the validity and applicability of our risk score in KD patients treated with a single infusion of 2 g/kg.
    Methods: We utilized a database of 1448 KD patients given IVIG (1 g/kg/day IVIG for 2 consecutive days, 962 KD patients; 2 g/kg/day within a day, 486 KD patients) at 15 hospitals in Gunma, Saitama, and Nagano prefectures, and metropolitan Tokyo from August 2000 to August 2008. We compared the accuracy of prediction by receiver operation characteristic (ROC) analysis.
    Result: Risk score points and clinical outcomes were similar in both groups. The area under the ROC curve to predict IVIG resistance were 0.82 (95% confidence interval (CI), 0.78-0.85) in 1 g/kg/day IVIG for 2 consecutive days, and 0.80 (95% CI, 0.75-0.85) in 2 g/kg/day IVIG within a day. Similarly, The area under the ROC curve to predict coronary artery lesions until a month were 0.78 (95% CI, 0.71-0.84) in 1 g/kg/day IVIG for 2 consecutive days and 0.78 (95% CI, 0.72-0.85) in 2 g/kg/day IVIG within a day.
    Conclusions: These findings indicated that we were able to apply our risk score to a regime of a single IVIG infusion of 2 g/kg.