Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance.


Journal Article

OBJECTIVES: 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. STUDY DESIGN: 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. RESULTS: 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. CONCLUSION: 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.

Full Text

Duke Authors

Cited Authors

  • Sleeper, LA; Minich, LL; McCrindle, BM; Li, JS; Mason, W; Colan, SD; Atz, AM; Printz, BF; Baker, A; Vetter, VL; Newburger, JW; Pediatric Heart Network Investigators,

Published Date

  • May 2011

Published In

Volume / Issue

  • 158 / 5

Start / End Page

  • 831 - 835.e3

PubMed ID

  • 21168857

Pubmed Central ID

  • 21168857

Electronic International Standard Serial Number (EISSN)

  • 1097-6833

Digital Object Identifier (DOI)

  • 10.1016/j.jpeds.2010.10.031


  • eng

Conference Location

  • United States