Kobayashi et al developed a score to help to identify a patient with Kawasaki Disease who may be unresponsive to intravenous immunoglobulin therapy. The authors are from Gunma University, Takasaki University of Health and Welfare and Gunma Children's Medical Center in Japan.
Patient selection: Kawasaki Disease
Outcome: failure to respond to intravenous infusion of immunoglobulin (IVIG)
Parameters:
(1) serum sodium concentration in mmol/L
(2) days of illness before initial treatment
(3) serum AST activity in IU/L
(4) percent neutrophils in the differential count
(5) serum CRP concentration in mg/dL
(6) age in months
(7) platelet count per µL
|
Parameter
|
Finding
|
Points
|
|
serum sodium
|
> 133 mmol/L
|
0
|
|
|
<= 133 mmol/L
|
2
|
|
days of illness before therapy started
|
<= 4
|
2
|
|
|
> 4
|
0
|
|
serum AST
|
< 100 IU/L
|
0
|
|
|
>= 100 IU/L
|
2
|
|
percent neutrophils
|
< 80%
|
0
|
|
|
>= 80%
|
2
|
|
serum CRP
|
< 10 mg/dL
|
0
|
|
|
>= 10 mg/dL
|
1
|
|
age
|
<= 12 months
|
1
|
|
|
> 12 months
|
0
|
|
platelet count
|
> 300,000 per µL
|
0
|
|
|
<= 300,000 per µL
|
1
|
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score 11
• The higher the score the more likely that the patient will be unresponsive to intravenous immunoglobulin therapy.
• A score >= 4 was used to identify a high risk population.
|
Score
|
Unresponsive
|
|
0
|
2.8%
|
|
1
|
2.3%
|
|
2
|
7.3%
|
|
3
|
7.3%
|
|
4
|
20%
|
|
5
|
30%
|
|
6
|
48%
|
|
7
|
67%
|
|
8
|
71%
|
|
9
|
88%
|
|
10 or 11
|
100%
|
Performance:
• The area under the ROC curve was 0.85.
