4.6 Article

Nomogram to predict risk of resistance to intravenous immunoglobulin in children hospitalized with Kawasaki disease in Eastern China

期刊

ANNALS OF MEDICINE
卷 54, 期 1, 页码 442-453

出版社

TAYLOR & FRANCIS LTD
DOI: 10.1080/07853890.2022.2031273

关键词

Kawasaki disease; LASSO regression; nomogram; prediction model; intravenous immunoglobulin resistance

资金

  1. National Natural Science Foundation of China [81971477, 81870365, 82070512, 81803116]
  2. Jiangsu Provincial Medical Young Talents [QNRC2016756]
  3. Applied Foundational Research of Medical and Health Care of Suzhou City [SYS2019086]
  4. Basic Research Project for Medical and Health Applications of Suzhou City [SYS2018077]
  5. Project of Education and Scientific Research for Young and Middleaged Teachers in Fujian Province [JAT200124]

向作者/读者索取更多资源

A nomogram was developed to predict the risk of resistance to intravenous immunoglobulin (IVIG) in children with Kawasaki disease in eastern China, using retrospective data analysis and external and prospective data validation. The nomogram showed satisfactory discriminatory power and could help reduce the risk of coronary artery lesions.
Objective We aimed to develop a nomogram to predict risk of resistance to intravenous immunoglobulin (IVIG) in children with Kawasaki disease in eastern China. Methods We retrospectively analysed the data of children with Kawasaki disease who received IVIG during hospitalisation at Soochow University Affiliated Children's Hospital. IVIG resistance was defined as recrudescent or persistent fever >= 36 h after the end of the IVIG infusion. Baseline variables were analysed using least absolute shrinkage and selection operator (LASSO) to identify the predictors of IVIG resistance, which were then used to construct a predictive nomogram. Calibration curve and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the model. The predictive nomogram was validated on test sets of external data and prospective data. Results Between January 2015 and December 2020, 1293 Kawasaki disease patients were hospitalized in Soochow University Affiliated Children's Hospital. Among them, 72 (5.57%) showed IVIG resistance. LASSO identified haemoglobin, percentage of neutrophils, C-reactive protein level, platelet count, serum albumin, serum sodium, serum alkaline phosphatase, coronary artery damage, and complete Kawasaki disease as risk factors for IVIG resistance. The nomogram constructed using these factors showed satisfactory discriminatory power (AUC, 0.75), and sensitivity (0.74) and specificity (0.64). In the external data and prospective data, the AUC was 0.66 and 0.83, respectively, the sensitivity was 0.86 and 1, respectively, and the specificity was 0.49 and 0.60, respectively. Conclusions The predictive nomogram constructed using nine factors associated with IVIG resistance in children with Kawasaki disease could be a useful tool for identifying patients likely to show IVIG resistance. This nomogram may help reduce the risk of coronary artery lesions. Key Messages None of the IVIG resistance scoring systems has shown consistently good performance in previous studies. Tools to predict the risk of IVIG resistance in eastern China are lacking. In our series, haemoglobin level, percentage of neutrophils, platelet count, coronary artery damage, incomplete Kawasaki disease, and CRP, serum albumin, serum sodium, and serum alkaline phosphatase levels were risk factors of IVIG resistance in hospitalized children in the eastern China cities of Suzhou and Fuzhou. We propose an easy-to-use nomogram to predict the risk factors of IVIG resistance in hospitalized children.

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