Risk factors and derived formosa score for intravenous immunoglobulin unresponsiveness in Taiwanese children with Kawasaki disease
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
5
Pages
350-355
Date Issued
2016
Author(s)
Chang C.-H.
Sun L.-C.
Liu H.-M.
Chang H.-W.
Abstract
Background/purpose: Kawasaki disease (KD) is the most common pediatric vasculitis. The study aimed to identify the risk factors of intravenous immunoglobulin (IVIG) unresponsiveness from the initial clinical parameters of the Taiwanese KD patients. Methods: We enrolled 248 KD (development dataset: 181, validation: 67) patients who received IVIG within 10 days after fever onset. IVIG unresponsiveness was defined by persistent fever beyond 24 hours after IVIG or recrudescent fever with KD symptoms. Results: From the development dataset (181 patients), IVIG unresponsiveness was noted in 22 patients (12.1%). The preIVIG levels of albumin, percentage of neutrophils, and positive lymphadenopathy were identified with highest risk for IVIG unresponsiveness. These three variables were used to construct a three-variable logistic regression model, which yielded an area under the receiver-operating-characteristics curve of 0.87. These three variables were further used to generate a composite scoring model (Formosa score) which yielded a sensitivity of 90.9% and specificity of 81.3% for a cut-off point of three or more. Validation in an independent cohort (67 KD patients) yielded sensitivity and specificity of 71.4% and 81.0%, respectively. Conclusion: We have established a simple three-variable Formosa score for KD patients to identify early those at risk of IVIG unresponsiveness for timely aggressive immunomodulation initially. ? 2015.
SDGs
Other Subjects
albumin; immunoglobulin; albuminoid; C reactive protein; immunoglobulin; Article; child; female; fever; Formosa score; human; lymphadenopathy; major clinical study; male; mucocutaneous lymph node syndrome; neutrophil; risk factor; scoring system; sensitivity and specificity; Taiwanese; treatment response; drug resistance; fever; infant; lymphadenopathy; mucocutaneous lymph node syndrome; multivariate analysis; preschool child; receiver operating characteristic; retrospective study; risk factor; severity of illness index; statistical model; Taiwan; treatment failure; validation study; Albumins; C-Reactive Protein; Child, Preschool; Drug Resistance; Female; Fever; Humans; Immunoglobulins, Intravenous; Infant; Logistic Models; Lymphadenopathy; Male; Mucocutaneous Lymph Node Syndrome; Multivariate Analysis; Retrospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Taiwan; Treatment Failure
Publisher
Elsevier B.V.
Type
journal article