ArticlePediatric rheumatology online journal2025
Novel risk scoring system for predicting intravenous immunoglobulin resistance and coronary artery aneurysm in Thai children with Kawasaki disease.
Article in Pediatric rheumatology online journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study aimed to develop an alternative risk scoring system for intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD) in Thai population.
methodsThis study is a retrospective and prospective study from January 2012 to September 2024. Data on demographics, clinical features, laboratory parameters, echocardiographic results, and outcomes were analyzed. Multivariable logistic regression was used to identify predictors for IVIG resistance and CAA.
resultsA total of 150 patients diagnosed with KD were enrolled. IVIG resistance occurred in 12.9% of cases. Independent predictors were neutrophil-to-lymphocyte ratio (NLR) ≥ 3.5 (aOR 25.0, 95%CI 2.92-214.3), neutrophil-to-lymphocyte platelet ratio (NLPR) ≥ 1.8 (aOR 11.83, 95%CI 2.24-62.28), and total bilirubin (TB) ≥ 0.9 mg/dL (aOR 3.51, 95%CI 1.21-10.23). A new risk scoring system for IVIG resistance demonstrated an AUC of 0.84 (95% CI 0.74-0.95). CAA developed in 31.6% of KD cases. Independent predictors included age ≤ 6 months (aOR 2.77, 95%CI 1.02-7.50), illness duration before IVIG ≥ 10 days (aOR 5.31, 95%CI 2.09-13.49), and C-reactive protein (CRP) ≥ 10 mg/dL (aOR 2.54, 95%CI 1.08-5.97). A new CAA risk scoring system was developed with an AUC of 0.74 (95% CI 0.64-0.83).
conclusionsThis study provided practical tools to identify high risk patients and optimize KD management. NLR, NLPR and TB are strong predictors of IVIG resistance, while younger age, delayed IVIG treatment, and high CRP are key predictors of CAA.
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