Comparison of different risk scoring systems for predicting intravenous immunoglobulin resistance in Chinese children with Kawasaki disease

Abstract Objective: This study aims to evaluate the predictive efficacies of 6 established scoring systems for intravenous immunoglobulin (IVIG) resistance to Kawasaki disease (KD) in Chinese children. Methods: We retrospectively analyzed KD patients treated at cardiovascular medical ward in our institution between January 2020 and December 2022. Data were analyzed in 6scoring systems (Egami, Formosa, Harada, Kobayashi, Lan and Yang). Results: We recruited 763 KD patients in our study, including 60 IVIG-resistant cases (7.9%). Our study indicated that IVIG resistance KD patients represent a higher risk of developing coronary arterial lesions (CALs) (P < 0.001). In determining IVIG resistance, the sensitivity and specificity varied among scoring systems (Egami, 33.3% and 87.2%; Formosa, 91.7% and 42.0%; Harada, 76.7% and 42.8%; Kobayashi, 66.7% and 79.2%; Lan, 68.3% and 73.0%; Yang, 65.0% and 76.4%, respectively). Our study discovered that neutrophilic granulocyte percentage (NE%) ≥ 72.3% was an independent risk factor associated with IVIG resistance. Conclusion: The Kobayashi, Lan and Yang scoring systems were shown to be appropriate for determining IVIG resistance in Chinese KD patients. Meanwhile, more consideration should be considered for KD patients with high NE% to reduce IVIG resistance.