Clinical characteristics and risk prediction model construction of children with Kawasaki disease complicated with pleural effusion
Objective To investigate the clinical features of pediatric Kawasaki disease(KD)complicated with pleural effusion(PE)and construct a clinical prediction model.Methods A retrospective review was conducted on clinical data of 462 children with KD from June 2017 to June 2023.Eleven KD children with PE were selected as the KD-PE group,and 118 patients without PE were selected as the KD control group.Using propensity score matching,the clinical data including clinical manifestation,auxiliary examination,treatment process and complications were collected and analyzed.Univariate and Lasso-Logistic regression were used to analyze influence factors of PE in children with KD.A line chart model for predicting KD-PE was constructed,and the prediction efficiency of the model was evaluated.Results The respiratory symptoms were generally mild in the KD-PE group,with 10 cases exhibiting mild PE.Two variables of C-reactive protein(CRP,OR=1.045,95%CI:1.009-1.082)and albumin(ALB,OR=0.755,95%CI:0.591-0.964)were screened out by Lasso regression and multi-factor Logistic regression to construct the prediction model.The regression equation was Logit(P)=2.221+0.044×CRP-0.281×ALB.The area under the ROC curve of the prediction model was 0.957(95%CI:0.911-1.000),and the Hosmer-Lemeshow test showed that the curve of the calibration model was well coincident with the curve of the actual model(χ2=4.320,P=0.827).The evaluation model using clinical decision curve and clinical impact curve had good clinical applicability.Conclusion KD complicated with PE in children is rare,elevated CRP is a risk factor for KD-complicated PE,and elevated ALB is a protective factor.The model has higher accuracy,discriminatory power and net benefit.
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