Procalcitonin as a Biomarker of Unresponsiveness to Intravenous Immunoglobulin for Kawasaki Disease
Procalcitonin as a Biomarker of Unresponsiveness to Intravenous Immunoglobulin for Kawasaki Disease
复制标题
DOI：
10.1097/inf.0000000000002716
复制
发表时间：
2020-09-01
影响因子：
3.6
通讯作者：
Okumura, Akihisa
中科院分区：
文献类型：
--
作者：
Nakamura, Nami;Muto, Taichiro;Okumura, Akihisa
目的：探讨降钙素原（PCT）作为静脉注射免疫球蛋白（IVIG）耐药川崎病患者预后因素的价值。方法：回顾性分析2014 - 2019年接受IVIG治疗的215例川崎病患儿的实验室资料。我们分析了IVIG前的临床和实验室参数，包括与IVIG反应相关的血清PCT水平。结果：最终对127例患者进行了分析。中位年龄为2.4岁。IVIG对108例有反应的儿童有效，对19例无反应的儿童无效。无应答者血清PCT浓度高于应答者（P< 0.001）。多因素logistic回归分析显示，较高的PCT浓度（优势比1.34,95%可信区间1.10-1.64）与IVIG耐药相关。患者工作特征曲线分析显示，PCT 2.18 ng/mL的截止值敏感性为46.4%，特异性为93.9%。受试者工作特征分析得出曲线下面积为0.82(0.72-0.92)，可预测IVIG耐药性。结论：血清PCT值具有较好的区分能力和现有的预测评分，可作为预测IVIG无反应的良好生物标志物。
Objective: To investigate the usefulness of procalcitonin (PCT) as predictive factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease patients. Methods: We retrospectively analyzed the laboratory data from 215 children with Kawasaki disease treated with IVIG from 2014 to 2019. We analyzed the clinical and laboratory parameters just before the IVIG including serum levels of PCT with respect to the IVIG response. Results: Eventually, 127 patients were analyzed. The median age was 2.4 years. IVIG was effective in 108 children (responders) and was ineffective in 19 (non-responders). Serum PCT concentration was higher in non-responders than those of responders (P< 0.001). Multivariate logistic regression analyses indicated that higher PCT concentration (odds ratio 1.34, 95% confidence interval 1.10-1.64) were associated with IVIG resistance. Analyses of the receiver operating characteristic curve showed that the cutoff value of PCT 2.18 ng/mL had 46.4% of sensitivity and 93.9% of specificity. Receiver operating characteristic analysis yielded an area under the curve of 0.82 (0.72-0.92) to predict IVIG resistance. Conclusions: Serum PCT value can be an excellent biomarker for predicting unresponsiveness to IVIG with a good discriminatory ability as well as the existing prediction scores.