Objective  To explore the influencing factors of intravenous immunoglobulin resistance (IVIGR) in children with Kawasaki disease (KD), and construct the IVIGR prediction model to provide the basis for the risk stratification nursing of children with KD.

Methods  Children with KD who were treated in Jiaxing Second Hospital from April 2020 to April 2023 were included in the study subjects. Children with KD were divided into IVIGR and non-IVIGR groups according to whether they developed IVIGR. Stepwise multivariate Logistic regression was used to explore the independent influencing factors of IVIGR in children with KD, and to construct a prediction model of IVIGR in children with KD. The predictive power, the calibration power, and the clinical net benefit of the IVIGR prediction models were evaluated using the receiver operating characteristic curve (ROC), calibration curves, and decision curves.

Results  A total of 120 children with KD, 22 in the IVIG group and 98 in the non-IVIGR group were included. Multivariate Logistic regression showed that hematocrit, total bilirubin, lactate dehydrogenase, and C-reactive protein/albumin ratio were independent influencing factors for the development of IVIGR in children with KD (P<0.05). The area under the ROC curve of the prediction model for IVIGR in KD children was 0.858, which had good predictive ability, calibration ability, and clinical net benefit.

Conclusion The IVIGR risk prediction model can be used to predict the occurrence of intravenous IV IGR in children with KD, and it is a simple and practical tool to achieve risk-graded care.

1.文雯. 动态心电图诊断川崎病合并冠状动脉损害的价值[J]. 医学新知, 2018, 28(4): 410-411. [Wen W. The value of dynamic electrocardiogram in diagnosing Kawasaki disease with coronary artery damage[J]. Yixue Xinzhi Zazhi, 2018, 28(4): 410-411.] DOI: 10.3969/j. issn.1004-5511.2018.04.020.

2.Gorelik M, Chung SA, Ardalan K, et al. 2021 American college of rheumatology/vasculitis foundation guideline for the management of Kawasaki disease[J]. Arthritis Rheumatol, 2022, 74(4): 586-596. DOI: 10.1002/acr.24838.

3.黄蕊, 赵红缨, 汤颖, 等. 丙种球蛋白无反应及敏感川崎病患儿血小板、干扰素-γ和白介素-6表达水平及其临床意义[J]. 广西医科大学学报, 2023, 40(4): 670-675. [Huang R, Zhao HY, Tang Y, et al. Platelets and interferons in children with Kawasaki disease who have no response or sensitivity to gammaglobulin-γ the expression levels of interleukin-6 and its clinical significance[J]. Journal of Guangxi Medical University, 2023, 40(4): 670-675.] DOI: 10.16190/j. cnki.45-1211/r.2023.04.022.

4.McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. DOI: 10.1161/CIR.0000000000000484.

5.Song MS. Predictors and management of intravenous immunoglobulin resistant Kawasaki disease[J]. Korean J Pediatr, 2019, 62(4): 119-123. DOI: 10.3345/kjp.2019. 00150.

6.Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 Guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. DOI: 10.1253/circj.CJ-19-1094.

7.栾进. 医院医疗质量风险预警体系的构建[D]. 重庆: 第三军医大学, 2010.

8.邢香芹, 唐若莹, 王二洁, 等. 基于感染风险评估分层的针对性护理对急性白血病化疗病人感染预防及生活质量的影响[J]. 蚌埠医学院学报, 2023, 48(9): 1282-1285. [Xing XQ, Tang RY, Wang EJ, et al. The impact of targeted nursing based on infection risk assessment stratification on infection prevention and quality of life in chemotherapy patients with acute leukemia[J]. Journal of Bengbu Medical College, 2023, 48(9): 1282-1285.] DOI: 10.13898/j.cnki.issn.1000-2200.2023.09.024.

9.范晶晶, 卞丽艳, 陈媛. 风险评估策略下的分层干预在髋关节置换术后患者护理中的应用[J]. 中国医药导报, 2022, 19(34): 194-197. [Fan JJ, Bian LY, Chen Y. The application of stratified intervention under risk assessment strategy in the nursing of patients after hip replacement surgery[J]. China Medical Journal, 2022, 19(34): 194-197.] DOI: 10.20047/j.issn1673-7210.2022.34.45.

10.Yu Q, Yan JS, Tian S, et al. A scoring system developed from a nomogram to differentiate active pulmonary tuberculosis from inactive pulmonary tuberculosis[J]. Front Cell Infect Microbiol, 2022, 12: 947954. DOI: 10.3389/fcimb.2022.947954.

11.Fabi M, Andreozzi L, Corinaldesi E, et al. Inability of Asian risk scoring systems to predict intravenous immunoglobulin resistance and coronary lesions in Kawasaki disease in an Italian cohort[J]. Eur J Pediatr, 2019, 178(3): 315-322. DOI: 10.1007/s00431-018-3297-5.

12.Sleeper LA, Minich LL, McCrindle BM, et al. Evaluation of Kawasaki disease risk-scoring systems for intravenous immunoglobulin resistance[J]. J Pediatr, 2011, 158(5): 831-835. e833. DOI: 10.1016/j.jpeds.2010.10.031.

13.Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease[J]. Circulation, 2006, 113(22): 2606-2612. DOI: 10.1161/CIRCULATIONAHA.105.592865.

14.Egami K, Muta H, Ishii M, et al. Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease[J]. J Pediatr, 2006, 149(2): 237-240. DOI: 10.1093/jpids/piw075.

15.Li X, Chen Y, Tang Y, et al. Predictors of intravenous immunoglobulin-resistant Kawasaki disease in children: a Meta-analysis of 4442 cases[J]. Eur J Pediatr, 2018, 177(8): 1279-1292. DOI: 10.1007/s00431-018-3182-2.

16.Wang JJ, Huang XH, Guo DH, et al. Predictors and a novel predictive model for intravascular immunoglobulin resistance in Kawasaki disease[J]. Ital J Pediatr, 2023, 49(1): 126. DOI: 10.1186/s13052-023-01531-7.

17.张丹凤, 钟家蓉, 王丹. 完全川崎病和不完全川崎病冠脉病变对比研究[J]. 临床儿科杂志, 2018, 36(1): 14-18. [Zhang DF, Zhong JR, Wang D. A comparative study of coronary artery lesions between complete and incomplete Kawasaki disease[J]. Journal of Clinical Pediatrics, 2018, 36(1): 14-18.] DOI: 10.3969/j.issn.1000-3606.2018.1.004.

18.雷紫琴, 栾飞, 高铭, 等. 细胞焦亡与心血管疾病的关系及中医药防治研究进展[J]. 中国中药杂志, 2023, 48(7): 1779-1791. [Lei ZQ, Luan F, Gao M, et al. The relationship between cell apoptosis and cardiovascular disease and research progress in traditional Chinese medicine prevention and treatment[J]. Chinese Journal of Traditional Chinese Medicine, 2023, 48(7): 1779-1791.] DOI: 10.19540/j.cnki.cjcmm.20221219.601.

19.邹公民, 马泽南. 探讨川崎病合并冠状动脉损伤患儿心率变异性的特点及临床价值[J]. 世界复合医学, 2021, 7(9): 12-15. [Zou GM, Ma ZN. Exploring the characteristics and clinical value of heart rate variability in children with Kawasaki disease complicated by coronary artery injury[J]. World Journal of Composite Medicine, 2021, 7(9): 12-15.] DOI: 10.11966/j.issn.2095-994X. 2021.07.09.04.

20.Sheinenzon A, Shehadeh M, Michelis R, et al. Serum albumin levels and inflammation[J]. Int J Biol Macromol, 2021, 184: 857-862. DOI: 10.1016/j.ijbiomac.2021.06.140.

21.肖霞, 乔玉梅. 宫颈癌患者手术前后外周血炎症相关细胞因子水平及护理干预[J]. 中国肿瘤临床与康复, 2019, 26(11): 1277-1280. [Xiao X, Qiao YM. Levels  of inflammatory cytokines in peripheral blood of cervical cancer patients before and after surgery and nursing interventions[J]. Chinese Journal of Cancer Clinical and Rehabilitation, 2019, 26 (11): 1277-1280.] DOI: 10.13455/j.cnki.cjcor.2019.11.34.

22.杨俊. 重组人干扰素-α2b阴道泡腾胶囊与护理干预对患者宫颈高危型HPV感染的疗效及其对炎症因子水平的影响[J]. 抗感染药学, 2019, 16(5): 909-911. [Yang J. Efficacy of recombinant human interferon-α2b vaginal effervescent capsule and nursing intervention on cervical high-risk HPV infection in patients and its effect on inflammatory factor levels[J]. Anti-Infection Pharmacy, 2019, 16(5): 909-911.] DOI: 10.13493/j.issn.1672-7878. 2019.05-063.