Evaluation of Kawasaki Disease Risk-Scoring Systems for Intravenous Immunoglobulin Resistance

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. We used data from a randomized trial of pulsed steroids for primary treatment of Kawasaki disease to assess operating ch...

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Vydané v:	The Journal of pediatrics Ročník 158; číslo 5; s. 831 - 835.e3
Hlavní autori:	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.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Mosby, Inc 01.05.2011
Predmet:	albumins algorithms aspartate transaminase Child, Preschool children coronary vessels Double-Blind Method Drug Resistance Female Follow-Up Studies Humans immunoglobulins Immunoglobulins, Intravenous - administration & dosage Immunologic Factors - administration & dosage Infant Infusions, Intravenous intravenous injection Japan Male Mucocutaneous Lymph Node Syndrome - diagnosis Mucocutaneous Lymph Node Syndrome - drug therapy patients Pediatrics prediction Prognosis Retrospective Studies risk risk factors ROC Curve steroids therapeutics Treatment Outcome Japan IVIG KD IVMP CA Kawasaki disease Coronary artery Intravenous immunoglobulin Intravenous methylprednisolone
ISSN:	0022-3476, 1097-6833, 1097-6833
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Popis
Shrnutí:	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. 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. 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. 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.
Bibliografia:	http://dx.doi.org/10.1016/j.jpeds.2010.10.031 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 ObjectType-Undefined-3 List of members of the Pediatric Heart Network Investigators is available at www.jpeds.com (Appendix).
ISSN:	0022-3476 1097-6833 1097-6833
DOI:	10.1016/j.jpeds.2010.10.031