Abstract O.47: Prediction of IVIG Resistance using Kawasaki Disease Risk Scores and Baseline Coronary Z-Scores at a Single North American Center
Aim: At a single pediatric tertiary care center, we assessed the performance of established Japanese risk scores (RS) to identify patients (pts) with Kawasaki Disease (KD) at higher risk for re-treatment (re-tx). We also sought to determine if the addition of baseline coronary Z-scores to RS could improve the prediction re-tx.
Methods: We reviewed available clinical, lab and echocardiogram (echo) data for KD pts treated from 1/2006 to 5/2014. The maximum z-score (zMax) of the right coronary artery (RCA) or left anterior descending artery (LAD) at baseline was used. Abnormal coronary arteries at baseline echo were defined as zMax ≥2 in the RCA or LAD. Kobayashi, Sano, Egami and Harada scores were calculated, comparing low and high risk scores to re-tx. The zMax was incorporated into each RS with 1 point added (+1) if baseline zMax ≥2. In an alternative approach, zMax was added as a covariate in a logistic regression model. The discrimination of each model was assessed using the c statistic.
Results: Of 339 pts, 214 (63%) were male, and median age was 3.2 y (range 0.1-14.1 y). At diagnosis, 29% (97/339) had ≤3 classical criteria for KD, and 25% (85/339) received IVIG re-tx. At baseline, the median zMax was 1.37 (-1.64-14.2) and 26% (88/339) had zMax ≥2. Classification as high risk by all four RS was significantly associated with re-tx (p<0.001-0.02). Baseline zMax <2 vs. ≥2 was also associated with re-tx (50 [21%] vs. 30 [34%], p<0.02). The ORs for re-tx were significant for all RS, but c-statistics were low, with a c statistic <0.7 (range of 0.57-0.61). RS +1 for zMax ≥2 did not improve the prediction for re-tx (c statistic 0.58-0.63). However, the addition of zMax ≥2 as a covariate improved the discrimination of all RS for re-tx (c-statistic 0.6-0.67).
Conclusions: Published RS for predicting IVIG resistance are associated with higher rates of re-tx in our patient population, but are not sufficient to discriminate patients at risk for re-tx. With the addition of baseline zMax as a covariate to the RS, prediction for re-tx was improved, although still modest. Further study in larger, multi-center studies are needed to validate these findings and to better understand the risk factors for re-tx in KD in North American children.
Author Disclosures: M.F. Son: None. S. Kim: None. K. Gauvreau: None. A. Tang: None. F. Dedeoglu: None. D. Fulton: None. M.S. Lo: None. R.P. Sundel: None. J.W. Newburger: None.
- © 2015 by American Heart Association, Inc.