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J Pediatr ; 158(5): 831-835.e3, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21168857

RESUMO

OBJECTIVES: To assess the performance of 3 risk scores from Japan that were developed to predict, in children with Kawasaki disease, resistance to intravenous immunoglobulin (IVIG) treatment. STUDY DESIGN: We used data from a randomized trial of pulsed steroids for primary treatment of Kawasaki disease to assess operating characteristics of the 3 risk scores, and we examined whether steroid therapy lowers the risk of coronary artery abnormalities in patients prospectively classified as IVIG resistant. RESULTS: For comparability with published cohorts, we analyzed the data of 99 patients who were not treated with steroids (16% IVIG-retreated) and identified male sex, lower albumin level, and higher aspartate aminotransferase level as independent risk factors for IVIG resistance. The Kobayashi score was similar in IVIG-resistant and -responsive patients, yielding a sensitivity of 33% and specificity of 87%. There was no interaction of high-risk versus low-risk status by treatment received (steroid versus placebo) with any of the 3 risk score algorithms. CONCLUSION: Risk-scoring systems from Japan have good specificity but low sensitivity for predicting IVIG resistance in a North American cohort. Primary steroid therapy did not improve coronary outcomes in patients prospectively classified as being at high-risk for IVIG resistance.


Assuntos
Resistência a Medicamentos , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Infusões Intravenosas , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
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