Predictive value of Albumin-Bilirubin grade for intravenous immunoglobulin resistance in a large cohort of patients with Kawasaki disease: a prospective study.
Predictive value of Albumin-Bilirubin grade for intravenous immunoglobulin resistance in a large cohort of patients with Kawasaki disease: a prospective study.
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白蛋白-胆红素等级对一大群川崎病患者静脉注射免疫球蛋白抵抗的预测价值：一项前瞻性研究
DOI：
10.1186/s12969-021-00638-7
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发表时间：
2021-09-25
期刊：
影响因子：
--
通讯作者：
Wang C
中科院分区：
文献类型：
--
作者：
Yan Y;Qiao L;Hua Y;Shao S;Zhang N;Wu M;Liu L;Zhou K;Liu X;Wang C
背景静脉注射免疫球蛋白（IVIG）耐药预测是KD的主要临床问题和研究热点之一。本研究旨在前瞻性地探讨白蛋白胆红素分级（ALBI）在预测IVIG抵抗KD和评估是否ALBI有更高的预测价值或准确性比无论是ALB或TBIL单独预测IVIG resistance.MethodsA共823例KD患者进行了前瞻性入组。比较IVIG应答组（n= 708）和IVIG抵抗组（n= 115）的临床和实验室数据。多因素Logistic回归分析确定IVIG抵抗的独立危险因素。受试者工作特征（ROC）曲线分析，以评估有效性的ALBI，ALB，TBIL在预测IVIG resistance.ResultsALBI是显着较高的IVIG抵抗患者，并被确定为一个独立的危险因素IVIG抵抗在KD。ALBI参数≥ − 2.57（AUC：0.705，95% CI：0.672-0.736），ALB ≤ 33.0 g/L（AUC：0.659，95% CI：0.626-0.692），TBil ≥ 16.0µmol/L（AUC：0.626，95%CI：0.592-0.659），产生的敏感性、特异性、PPV和NPV分别为0.617、0.657、0.226和0.914; 0.374、0.850、0.289和0.893;结论高ALBI是川崎病IVIG耐药的独立危险因素。它产生了更好的预测能力比ALB和TBil单独的初始IVIG抵抗。
BackgroundIntravenous immunoglobulin (IVIG) resistance prediction is one of the primary clinical issues and study hotspots in KD. This study aimed to prospectively investigate the value of albumin-bilirubin grade (ALBI) in predicting IVIG resistance in KD and to assess whether ALBI has more predictive value or accuracy than either ALB or TBil alone in predicting IVIG resistance.MethodsA total of 823 patients with KD were prospectively enrolled. The clinical and laboratory data were compared between the IVIG-response group (n= 708) and the IVIG-resistance group (n= 115). Multivariate logistic regression analysis was performed to identify the independent risk factors for IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of ALBI, ALB, and TBil in predicting IVIG resistance.ResultsALBI was significantly higher in patients with IVIG resistance and was identified as an independent risk factor for IVIG resistance in KD. The parameter of ALBI ≥ − 2.57 (AUC: 0.705, 95 %CI: 0.672–0.736), ALB ≤ 33.0 g/L (AUC: 0.659, 95 %CI: 0.626–0.692), and TBil ≥ 16.0µmol/L (AUC: 0.626, 95 %CI: 0.592–0.659), produced a sensitivity, specificity, PPV, and NPV of 0.617, 0.657, 0.226 and 0.914; 0.374, 0.850, 0.289 and 0.893; 0.269, 0.941, 0.425 and 0.888, respectively.ConclusionsA higher ALBI was an independent risk factor for IVIG resistance in KD. It yielded better predictive ability than ALB and TBil alone for initial IVIG resistance.
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