Published Online
on May 30, 2006

A more recent version of this article appeared on June 6, 2006

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Submitted on October 3, 2005
Revised on March 2, 2006
Accepted on March 24, 2006

Prediction of Intravenous Immunoglobulin Unresponsiveness in Patients With Kawasaki Disease

Tohru Kobayashi MD^*, Yoshinari Inoue MD, Kazuo Takeuchi MD, MPH, Yasunori Okada MD, Kazushi Tamura MD, Takeshi Tomomasa MD, Tomio Kobayashi MD, and Akihiro Morikawa MD

From the Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine (Tohru Kobayashi, Y.I., Y.O., K. Tamura, T.T., A.M.); Department of Health and Welfare, Takasaki University of Health and Welfare (K. Takeuchi); Department of Cardiology, Gunma Children’s Medical Center (Tomio Kobayashi), Gunma, Japan.

^* To whom correspondence should be addressed. E-mail: torukoba{at}nifty.com.

Background--In the present study, we developed models to predict unresponsiveness to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD).

Methods and Results--We reviewed clinical records of 546 consecutive KD patients (development dataset) and 204 subsequent KD patients (validation dataset). All received IVIG for treatment of KD. IVIG nonresponders were defined by fever persisting beyond 24 hours or recrudescent fever associated with KD symptoms after an afebrile period. A 7-variable logistic model was constructed, including day of illness at initial treatment, age in months, percentage of white blood cells representing neutrophils, platelet count, and serum aspartate aminotransferase, sodium, and C-reactive protein, which generated an area under the receiver-operating-characteristics curve of 0.84 and 0.90 for the development and validation datasets, respectively. Using both datasets, the 7 variables were used to generate a simple scoring model that gave an area under the receiver-operating-characteristics curve of 0.85. For a cutoff of 0.15 or more in the logistic regression model and 4 points or more in the simple scoring model, sensitivity and specificity were 86% and 67% in the logistic model and 86% and 68% in the simple scoring model. The kappa statistic is 0.67, indicating good agreement between the logistic and simple scoring models.

Conclusions--Our predictive models showed high sensitivity and specificity in identifying IVIG nonresponders among KD patients.

Key words: intravenous immunoglobulin • nonresponder • prediction • Kawasaki disease • risk factor

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