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Background <p>This study aimed to develop an alternative risk scoring system for intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD) in Thai population.</p> Methods <p>This study is a retrospective and prospective study from January 2012 to September 2024. Data on demographics, clinical features, laboratory parameters, echocardiographic results, and outcomes were analyzed. Multivariable logistic regression was used to identify predictors for IVIG resistance and CAA.</p> Results <p>A total of 150 patients diagnosed with KD were enrolled. IVIG resistance occurred in 12.9% of cases. Independent predictors were neutrophil-to-lymphocyte ratio (NLR) ≥ 3.5 (aOR 25.0, 95%CI 2.92–214.3), neutrophil-to-lymphocyte platelet ratio (NLPR) ≥ 1.8 (aOR 11.83, 95%CI 2.24–62.28), and total bilirubin (TB) ≥ 0.9&#xa0;mg/dL (aOR 3.51, 95%CI 1.21–10.23). A new risk scoring system for IVIG resistance demonstrated an AUC of 0.84 (95% CI 0.74–0.95). CAA developed in 31.6% of KD cases. Independent predictors included age ≤ 6 months (aOR 2.77, 95%CI 1.02–7.50), illness duration before IVIG ≥ 10 days (aOR 5.31, 95%CI 2.09–13.49), and C-reactive protein (CRP) ≥ 10&#xa0;mg/dL (aOR 2.54, 95%CI 1.08–5.97). A new CAA risk scoring system was developed with an AUC of 0.74 (95% CI 0.64–0.83).</p> Conclusions <p>This study provided practical tools to identify high risk patients and optimize KD management. NLR, NLPR and TB are strong predictors of IVIG resistance, while younger age, delayed IVIG treatment, and high CRP are key predictors of CAA.</p>

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Novel risk scoring system for predicting intravenous immunoglobulin resistance and coronary artery aneurysm in Thai children with Kawasaki disease

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  • 发表日期：

    2025年12月29日

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  • Poomrapee Tantikittipisut,
  • Ankavipar Saprungruang,
  • Roongroj Manatpreeprem,
  • Parichat Khaosut

摘要

Background

This study aimed to develop an alternative risk scoring system for intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD) in Thai population.

Methods

This study is a retrospective and prospective study from January 2012 to September 2024. Data on demographics, clinical features, laboratory parameters, echocardiographic results, and outcomes were analyzed. Multivariable logistic regression was used to identify predictors for IVIG resistance and CAA.

Results

A total of 150 patients diagnosed with KD were enrolled. IVIG resistance occurred in 12.9% of cases. Independent predictors were neutrophil-to-lymphocyte ratio (NLR) ≥ 3.5 (aOR 25.0, 95%CI 2.92–214.3), neutrophil-to-lymphocyte platelet ratio (NLPR) ≥ 1.8 (aOR 11.83, 95%CI 2.24–62.28), and total bilirubin (TB) ≥ 0.9 mg/dL (aOR 3.51, 95%CI 1.21–10.23). A new risk scoring system for IVIG resistance demonstrated an AUC of 0.84 (95% CI 0.74–0.95). CAA developed in 31.6% of KD cases. Independent predictors included age ≤ 6 months (aOR 2.77, 95%CI 1.02–7.50), illness duration before IVIG ≥ 10 days (aOR 5.31, 95%CI 2.09–13.49), and C-reactive protein (CRP) ≥ 10 mg/dL (aOR 2.54, 95%CI 1.08–5.97). A new CAA risk scoring system was developed with an AUC of 0.74 (95% CI 0.64–0.83).

Conclusions

This study provided practical tools to identify high risk patients and optimize KD management. NLR, NLPR and TB are strong predictors of IVIG resistance, while younger age, delayed IVIG treatment, and high CRP are key predictors of CAA.