Factors affecting the efficacy of intravenous gammaglobulin combined with aspirin in the treatment of Kawasaki disease and the construction of a prediction model
Objective To explore the influencing factors of the therapeutic effect of intravenous immunoglobulin (IVIG) combined with aspirin (ASP) in the treatment of Kawasaki disease (KD).Methods The clinical data of children with KD who were treated in the Department of Pediatrics of Anqing First People's Hospital of Anhui Medical University from June lst,2021 to May 31,2024 were retrospectively analyzed.They were divided into the effective group and the ineffective group according to the therapeutic effect.Univariate analysis was used to explore the differences in clinical characteristics between the two groups.Multivariate Logistic regression analysis was used to explore the independent risk factors for ineffective treatment in children with KD,and the Nomogram was constructed using R software.Receiver operating characteristic (ROC) curve,calibration curve,and decision curve analysis (DCA) were used to evaluate the discriminatory ability,calibration degree,and clinical benefit of the Nomogram,respectively.Results A total of 80 children with KD were included in this study,with 59 cases in the effective group and 21 cases in the ineffective group.Univariate analysis showed that there were significant statistical differences in fever duration,IVIG resistance (IVIGR),gastrointestinal bleeding,procalcitonin (PCT),C-reaction protein (CRP),interleukin-6 (IL-6),albumin (ALB) and erythrocyte sedimentation rate (ESR) between the two groups (P<0.05).In addition,there was no statistical significance in the comparisons of age,gender,body-mass index,average monthly family income,premature infants,coronary artery lesions and respiratory tract infection between the two groups (P>0.05).The results of multivariate Logistic regression showed that IVIGR (yes),PCT (≥0.96 ng/mL),CRP (≥41.98 mg/L),ALB (≤30.74 g/L) and ESR (≥17.92 mm/h) were independent risk factors for ineffective treatment in children with KD.ROC analysis showed that the area under the curve of the Nomogram for predicting ineffective treatment in children with KD was 0.989;the calibration curve suggested that the predicted probability of the Nomogram was approximately consistent with the actual probability,and the DCA suggested that when the risk threshold of the Nomogram was 0.912,the clinical net benefit of using the Nomogram was higher than that of not using the Nomogram model.Conclusion IVIGR (yes),PCT (≥0.96 ng/mL),CRP (≥41.98 mg/L),ALB (≤30.74 g/L),and ESR (≥17.92 mm/h) can be used to predict poor efficacy in children with KD.
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