A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients
A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients
复制标题
DOI：
10.1038/s41598-019-39330-y
复制
发表时间：
2019-02-11
影响因子：
4.6
通讯作者：
Tian, Jie
中科院分区：
文献类型：
--
作者：
Tan, Xu-Hai;Zhang, Xiao-Wei;Tian, Jie
准确评估静脉注射免疫球蛋白(IVIG)耐药的个体风险对于川崎病(KD)患者采用首次治疗和预防冠状动脉病变(CALS)的治疗方案至关重要。方法：对2007-10/2017-12重庆市中国西区儿童医院收治的KD患者进行回顾性分析。收集数据并比较IVIG抵抗组和IVIG反应组之间的差异。采用多元回归分析确定独立危险因素。建立了新的预测模型，并与以往的预测模型进行了比较。结果：共调查5277人，确定了8个独立危险因素：红细胞分布宽度(RDW)高、血小板计数(PLT)低、淋巴细胞百分率(P-Lym)低、总胆汁酸(TBA)高、白蛋白低、血钠水平低、CALS程度高(D-CALS)和年龄较小。新的预测模型的AUC为0.74，敏感性为76%，特异性为59%。对于IVIG抵抗的个体风险概率，给出了一个方程。结论：RDW、PLT、P-LYM、TBA、白蛋白、血钠水平、D-CALS和年龄可以预测IVIG抵抗。新模型对重庆市KD人群的预测效果优于以往的模型。
Accurate evaluation of individual risk of intravenous immunoglobin (IVIG)-resistance is critical for adopting regimens for the first treatment and prevention of coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods: The KD patients hospitalized in Chongqing Children's Hospital, in west China, from October 2007 to December 2017 were retrospectively reviewed. Data were collected and compared between IVIG-resistant group and IVIG-responsive group. The independent risk factors were determined using multivariate regression analysis. A new prediction model was built and compared with the previous models. Results: A total of 5277 subjects were studied and eight independent risk factors were identified including higher red blood cell distribution width (RDW), lower platelet count (PLT), lower percentage of lymphocyte (P-LYM), higher total bile acid (TBA), lower albumin, lower serum sodium level, higher degree of CALs (D-CALs) and younger age. The new predictive model showed an AUC of 0.74, sensitivity of 76% and specificity of 59%. For individual's risk probability of IVIG-resistance, an equation was given. Conclusions: IVIG-resistance could be predicted by RDW, PLT, P-LYM, TBA, albumin, serum sodium level, D-CALs and age. The new model appeared to be superior to those previous models for KD population in Chongqing city.