Risk factors and derived formosa score for intravenous immunoglobulin unresponsiveness in Taiwanese children with Kawasaki disease
Risk factors and derived formosa score for intravenous immunoglobulin unresponsiveness in Taiwanese children with Kawasaki disease
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DOI：
10.1016/j.jfma.2015.03.012
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发表时间：
2016-05-01
影响因子：
3.2
通讯作者：
Wu, Mei-Hwan
中科院分区：
文献类型：
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作者：
Lin, Ming-Tai;Chang, Chin-Hao;Wu, Mei-Hwan
背景/目的：川崎病（KD）是最常见的小儿血管炎。本研究的目的是确定的风险因素静脉注射免疫球蛋白（IVIG）无反应的初始临床参数的台湾KD patients.Methods：我们招募了248 KD（开发数据集：181，验证：67）患者接受IVIG在10天内发热发作。IVIG无反应性定义为持续发热超过24小时后IVIG或复发发热KD symptoms.Results：从开发数据集（181例），IVIG无反应性注意到22例（12.1%）。IVIG前白蛋白水平、中性粒细胞百分比和淋巴结肿大阳性被认为是IVIG无反应的最高风险。这三个变量被用来构建一个三变量逻辑回归模型，得出受试者操作特征曲线下面积为0.87。这三个变量进一步用于生成复合评分模型（福尔摩沙评分），对于3个或更多的临界点，该模型产生90.9%的灵敏度和81.3%的特异性。在一个独立的队列（67 KD患者）的验证产生的敏感性和特异性分别为71.4%和81.0%.Conclusion：我们已经建立了一个简单的三变量福尔摩沙评分KD患者及时积极的免疫调节，以确定早期IVIG无反应的风险。版权所有（C）2015，台湾医学会.出版社：Elsevier Taiwan LLC
Background/purpose: Kawasaki disease (KD) is the most common pediatric vasculitis. The study aimed to identify the risk factors of intravenous immunoglobulin (IVIG) unresponsiveness from the initial clinical parameters of the Taiwanese KD patients.Methods: We enrolled 248 KD (development dataset: 181, validation: 67) patients who received IVIG within 10 days after fever onset. IVIG unresponsiveness was defined by persistent fever beyond 24 hours after IVIG or recrudescent fever with KD symptoms.Results: From the development dataset (181 patients), IVIG unresponsiveness was noted in 22 patients (12.1%). The preIVIG levels of albumin, percentage of neutrophils, and positive lymphadenopathy were identified with highest risk for IVIG unresponsiveness. These three variables were used to construct a three-variable logistic regression model, which yielded an area under the receiver-operating-characteristics curve of 0.87. These three variables were further used to generate a composite scoring model (Formosa score) which yielded a sensitivity of 90.9% and specificity of 81.3% for a cut-off point of three or more. Validation in an independent cohort (67 KD patients) yielded sensitivity and specificity of 71.4% and 81.0%, respectively.Conclusion: We have established a simple three-variable Formosa score for KD patients to identify early those at risk of IVIG unresponsiveness for timely aggressive immunomodulation initially. Copyright (C) 2015, Formosan Medical Association. Published by Elsevier Taiwan LLC.