59 - EVALUATING THE EFFICACY OF ESTABLISHED SCORES IN PREDICTING IVIG RESISTANCE IN INFANT KAWASAKI DISEASE

Background: Patients diagnosed with KD may experience persistent or recurrent fever in approximately 10% to 20% of cases despite appropriate treatment with IVIG and aspirin. Infants, in particular, exhibit a higher rate of incomplete KD compared to other age groups, with an elevated risk of CA abnormalities. This study aimed to assess the applicability of existing risk scoring systems developed to predict nonresponse to IVIG in infant KD patients.


Methods: A retrospective analysis was conducted on 143 infants admitted to Kyungpook national university children’s hospital with KD from January 2019 to December 2023. Patients were retrospectively categorized into groups based on the presence or absence of IVIG resistance. Demographic data, clinical information, and laboratory results were compared and analyzed between the IVIG-resistant and non-resistant groups. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Egami, Kobayashi, and Sano scoring systems. The discriminatory capacity of each system was evaluated using the area under the receiver operating characteristic (ROC) curves.



Results: The mean age of the 143 participants was 6.9±2.6 months, with 95 individuals (66.4%) being male. There were 45 patients (31.5%) in the IVIG resistance group. Significant differences between the groups with and without IVIG resistance were observed in the rates of CA abnormality (15.6% versus 5.1%, p=0.036) and total hospitalization duration. Additionally, CRP (p=0.018), total bilirubin (p=0.003), and albumin (p=0.008) showed significant differences between the two groups. The Egami score demonstrated a sensitivity of 35.6%, specificity of 77.6%, PPV of 42.1%, NPV of 72.4%, and an area under the ROC curve (AUC) of 0.583 (95% confidence interval [CI] 0.481-0.684). The Kobayashi score exhibited a sensitivity of 55.6%, specificity of 63.3%, PPV of 41%, NPV of 75.6%, and an AUC of 0.610 (95% CI 0.507-0.713). The Sano score had a sensitivity of 20%, specificity of 95.9%, PPV of 69.2%, NPV of 72.3%, and an AUC of 0.674 (95% CI 0.573-0.774).

Conclusion: The three well-established scores commonly used to predict IVIG resistance did not perform effectively in predicting IVIG resistance when specifically applied to infant KD. Therefore, there is a need for the development of a new and dedicated IVIG resistance prediction scoring system tailored for infant KD.