Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Prediction of Intravenous Immunoglobulin Nonresponse Kawasaki Disease in Korea

한국인에서 면역글로불린-저항성 가와사키병 환자의 예측

  • Choi, Myung Hyun (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Park, Chung Soo (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Kim, Dong Soo (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Kim, Ki Hwan (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
  • 최명현 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 박청수 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 김동수 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과) ;
  • 김기환 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과)
  • Received : 2013.09.15
  • Accepted : 2013.10.22
  • Published : 2014.04.25
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Abstract

Purpose: The objective of this study was to find the predictors and generate a prediction scoring model of nonresponse to intravenous immunoglobulin in patients with Kawasaki disease. Methods: We examined 573 children diagnosed with KD at the Severance Children's Hospital between January 2009 and december 2012. We retrospectively reviewed their medical records. These patients were divided into 2 groups; the experimental group (N=433) and the validation group (N=140). Each group were divided into 2 groups the intravenous immunoglobulin nonresponders and the responders. Multivariate logistic regression analysis identified predictive factors of intravenous immunoglobulin nonresponders which make predictive scoring model. We practice internal validation and external validation. Results: Multivariate logistic regression analysis identified male, cervical lymphadenopathy, changes of the extremities, platelet, total bilirubin, alkaline phophatase, lactate dehydrogenase, C-reactive protein as significant predictors for nonresponse to intravenous immunoglobulin. We generated prediction score assigning 1 point for (1) male, (2) cervical lymphadenopathy, (3) changes of the extremities, (4) platelet (${\leq}368,000/mm^3$), (5) total bilirubin (${\geq}0.4mg/dL$), (6) alkaline phophatase (${\geq}227IU/L$), (7) lactate dehydrogenase (${\geq}268IU/L$), (8) C-reactive protein (>77.1 mg/dL). Using a cut-off point of 4 and more with this prediction score, we could identify the intravenous immunoglobulin nonresponder group. Sensitivity and specificity were 52.5% and 82.4% in experimental group and 37.8% and 81.8% in validation group, respectively. Conclusion: Our predictive scoring models had high specificity and low sensitivity in Korean patients. Therefore it is useful in predicting nonresponse to intravenous immunoglobulin with Kawasaki disease.

목적: 이 연구의 목적은 면역글로불린-저항성 가와사키병의 예측 인자를 찾고 점수화된 예측 모델을 만들고자 하는 것이다. 방법: 2009년 1월부터 2012년 12월까지 세브란스 어린이 병원에서 가와사키병으로 진단된 573명의 환자를 대상으로 하였다. 실험군과 검증군으로 나누었고, 각 군들은 면역글로불린-반응성과 저항성으로 나누었다. 실험군에서 면역글로불린의 예측 인자를 찾았고, 점수화된 예측모델을 만들었다. 그리고 외적, 내적 타당성 검증을 시행하였다. 결과: 남성, 경부림프절종대, 손과 발의 변화, 혈소판, 총빌리루빈, 젖산탈수효소, CRP가 면역글로불린-저항성 가와사키병의 예측 인자로 나타났다. 점수화된 예측 모델을 만들었고, 민감도와 특이도가 실험군에서는 52.5%와 82.4%, 검증군에서는 37.8%와 81.8%로 나타났다. 결론: 우리의 점수화된 예측 모델은 한국 환자에 적용하였을 때 높은 특이도와 낮은 민감도를 갖는다.

Keywords

References

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