Japanese scoring systems to predict resistance to intravenous immunoglobulin in Kawasaki disease were unreliable for Caucasian Israeli children

• DOI: 10.1111/apa.14418
• Publication Date: 2018-05-24T07:19:07Z
• Authors: Karen Arane; Kerry Mendelsohn; Michael Mimouni; Francis Mimouni; Yael Koren; Dafna Brik Simon; Hilla Bahat; Mona Hanna Helou; Amir Mendelson; Nofar Hezkelo; Miguel Glatstein; Yackov Berkun; Eli Eisenstein; Yonatan Aviel Butbul; Riva Brik; Philip J. Hashkes; Yosef Uziel; Liora Harel; Gil Amarilyo
• Keywords: Male; Coronary Aneurysm; Immunoglobulins, Intravenous; Mucocutaneous Lymph Node Syndrome; Risk Assessment; White People; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Female; Treatment Failure; Retrospective Studies

AbstractAimThis study assessed the validity of using established Japanese risk scoring methods to predict intravenous immunoglobulin (IVIG) resistance to Kawasaki disease in Israeli children.MethodsWe reviewed the medical records of 282 patients (70% male) with Kawasaki disease from six Israeli medical centres between 2004 and 2013. Their mean age was 2.5 years. The risk scores were calculated using the Kobayashi, Sano and Egami scoring methods and analysed to determine whether a higher risk score predicted IVIG resistance in this population. Factors that predicted a lack of response to the initial IVIG dose were identified.ResultsWe found that 18% did not respond to the first IVIG dose. The three scoring methods were unable to reliably predict IVIG resistance, with sensitivities of 23%–32% and specificities of 67%–87%. Calculating a predictive score that was specific for this population was also unsuccessful. The factors that predicted a lacked of response to the first IVIG dose included low albumin, elevated total bilirubin and ethnicity.ConclusionThe established risk scoring methods created for Japanese populations with Kawasaki disease were not suitable for predicting IVIG resistance in Caucasian Israeli children, and we were unable to create a specific scoring method that was able to do this.