Failure to Predict High-risk Kawasaki Disease Patients in a Population-based Study Cohort in Germany
Failure to Predict High-risk Kawasaki Disease Patients in a Population-based Study Cohort in Germany
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DOI：
10.1097/inf.0000000000001923
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发表时间：
2018-09-01
影响因子：
3.6
通讯作者：
Obermeier, Viola
中科院分区：
文献类型：
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作者：
Jakob, Andre;von Kries, Rudiger;Obermeier, Viola
背景：在日本人群中，高危川崎病(KD)患者的不同评分已被证明具有良好的预后有效性。然而，关于非日本人的数据一直没有定论。在德国以高加索为主的人群中，小林、江上和佐野的评分或应用最新的统计方法(随机森林)是否可以预测标准静脉免疫球蛋白(IVIG)治疗的反应和持续性冠状动脉动脉瘤(CAA)的风险？方法：使用442名儿童的数据(2013年和2014年德国人口调查)来评估小林、江上和佐诺评分对IVIG治疗无效的预后有效性和预测持续性CAA的风险。此外，应用最新的统计方法(随机森林)来确定潜在的更有效的分数。结果：共有301名儿童符合IVIG治疗反应的评估标准。其中177名儿童接受为期1年的随访，以确定持续性CAA。虽然所有评分均与IVIG难治有关(相对危险度在2.32~3.73之间)，但预后较低(似然比阳性：1.83~4.57；敏感度在0.28~0.53之间)。这些分数都不是急性疾病后1年CAA的显著预测因子。应用随机森林等统计分析并没有得到更有效的评分。结论：现有的评分似乎都不适合识别患有KD的高加索高危儿童，他们可能需要加强治疗。
Background: Diverse scores on high-risk Kawasaki disease (KD) patients have proven a good prognostic validity in the Japanese population. However, data on non-Japanese have been inconclusive. Do the Kobayashi, Egami and Sano scores or application of up-to-date statistical methods (Random Forest) predict response to standard intravenous immunoglobulin (IVIG) therapy and the risk of persistent coronary artery aneurysm (CAA) in patients with KD in a mainly Caucasian population in Germany?Methods: Data on 442 children (German population-based survey, 2013 and 2014) were used to assess the prognostic validity of the Kobayashi, Egami and Sano scores for being refractory to IVIG treatment and for predicting the risk of persistent CAA. Additionally, an up-to-date statistical approach (Random Forest) was applied to identify a potentially more valid score.Results: A total of 301 children were eligible for assessment of their response to IVIG treatment. Among those, 177 children were followed-up for 1 year to identify persistent CAA. Although all scores were significantly associated with being refractory to IVIG (relative risk range between 2.32 and 3.73), the prognostic properties were low (likelihood ratio positive: 1.83-4.57; sensitivity in the range of 0.28-0.53). None of the scores was a significant predictor of CAA 1 year after acute illness. Application of statistical analysis such as Random Forest did not yield a more valid score.Conclusions: None of the available scores appears to be appropriate for identifying high-risk Caucasian children with KD who might need intensified therapy.