Predictors of Egami et al for Resistance to Intravenous Immunoglobulin Therapy in a Patient with Kawasaki Disease

 

Parameters:

(1) age in months

(2) days of illness

(3) platelet count in 10^10/L (NOTE: not 10^9/L)

(4) serum ALT in IU/L

(5) C-reactive protein (CRP) in mg/dL

 

Parameter	Finding	Points
age in months	>= 6 months	0
	< 6 months	1
days of illness	>= 4 days	0
	< 4 days	1
platelet count	> 300,000 per µL (> 30 * 10^10/L)	0
	<= 300,000 per µL	1
CRP	< 8 mg/dL	0
	>= 8 mg/dL	1
ALT	< 80 IU/L	0
	>= 80 IU/L	2

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• The cutoff is >= 3 for the resistant groups.

 

Performance:

• The sensitivity for >= 3 was 78% sensitive and 76% specific.

• The positive predictive value is 32% and the negative predictive value is 96%.

 

Limitations:

• The reference ranges and methods for CRP and ALT

 

The authors also listed a multivariate logistic regression equation.

 

X =

= (0.016 * (age in months)) + (0.208 * (illness in days)) + (0.036 * (platelet count in 10^10/L)) - (0.004 * (ALT)) - (0.140 * (CRP)) + 1.084

 

probability =

= 1 / (1 + EXP((-1) * X))

 

When values are put in that indicate resistance by the simple score, then the probability is near 0. If values are put in that indicate response, then the probability is near 1. This is interpreted as meaning that the probability is for response to IVIG therapy.