A nomogram based on serum CHI3L1 for predicting IVIG nonresponse in children with Kawasaki disease.

Jialin Zou, Yan Duan, Dinghua Luo, Dong Liu, Bin Liu, Jian Zhao, Gang Li

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Article in European journal of pediatrics, 2026. 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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5 · Who and what money

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7 authors.

Jialin Zou *Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.

Yan Duan *Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.

Dinghua LuoDepartment of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.

Dong LiuDepartment of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.

Bin LiuDepartment of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.

Jian ZhaoDepartment of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China. zhao7253@126.com.ORCID http://orcid.org/0009-0008-0356-537X

Gang LiDepartment of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China. 479719170@qq.com.ORCID http://orcid.org/0000-0002-0654-8232

Funding

Clinical Medicine Program of Southwest Medical University NO.2024LCYXZX48Luzhou Municipal People's Government-Southwest Medical University Science and Technology strategic cooperation NO. 2023LZXNYDJ042

6 · The paper itself

Abstract

To investigate the value of serum chitinase-3-like protein 1 (CHI3L1) in predicting intravenous immunoglobulin (IVIG) nonresponse in children with Kawasaki disease (KD) and to develop a prediction model incorporating CHI3L1.This study enrolled 152 KD children (23 IVIG nonresponders, 129 IVIG-responders). Serum CHI3L1 levels were measured before IVIG infusion using an enzyme-linked immunosorbent assay (ELISA). Independent predictors were identified by univariate and multivariate logistic regression analyses, and a nomogram was constructed. The model performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA), clinical impact curve (CIC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).Serum CHI3L1 levels were significantly higher in the IVIG-nonresponsive group. Multivariate analysis identified CHI3L1 and C-reactive protein (CRP) as independent risk factors for IVIG nonresponse. The nomogram incorporating these two factors achieved an AUC of 0.83, with a sensitivity of 0.91 and a specificity of 0.67. Compared to CHI3L1 or CRP alone, the nomogram provided significant NRI and IDI. Both the calibration curve and DCA demonstrated favorable accuracy and clinical utility of the model.

conclusionSerum CHI3L1 is an independent predictor of IVIG nonresponse in KD. The nomogram combining CHI3L1 and CRP shows favorable predictive performance and may serve as a practical tool for early identification of IVIG-nonresponsive patients. WHAT IS KNOWN: • Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease, and IVIG nonresponse increases the risk of coronary artery lesions. • Several biomarkers and scoring systems have been proposed to predict IVIG resistance, but their generalizability and performance remain limited. WHAT IS NEW: • Serum CHI3L1, a chitinase family protein, is identified for the first time as an independent predictor of IVIG nonresponse in KD. • A novel nomogram integrating CHI3L1 and CRP demonstrates excellent predictive performance, with high sensitivity and improved net reclassification.

Indexed as

Chitinase-3-Like Protein 1Immunoglobulins, IntravenousMucocutaneous Lymph Node SyndromeNomogramsBiomarkersChildChild, PreschoolC-Reactive ProteinFemaleHumansInfantMalePredictive Value of TestsROC CurveBiomarkersCHI3L1 protein, humanChitinase-3-Like Protein 1C-Reactive ProteinImmunoglobulins, IntravenousBiomarkersCHI3L1 proteinDrug resistanceHumanIntravenous immunoglobulinKawasaki diseaseNomograms

Identifiers

PMID41495546

DOI10.3390/children10050772

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.