Verification of "Japanese Scoring Systems" to Predict IVIG Resistance and Identification of Predictors for IVIG Resistance in Thai Children with Kawasaki Disease.

The objective of this study was to assess the validity of using the Kobayashi, Sano and Egami scoring systems to predict the intravenous immunoglobulin (IVIG) resistance of Kawasaki disease (KD) and to identify the predictors of IVIG resistance in our Thai population. A retrospective study involving 130 KD patients who were admitted between January 2005 and April 2018 was performed. We found that 17 (13%) KD patients did not respond to the first IVIG dose. The three scoring systems have good specificity (80.8%, 74% and 92.1%, respectively) but low sensitivity (0%, 33.3% and 22.2%, respectively). Multivariate analysis suggested that a body temperature greater than 40.2 °C (odds ratio of 3.80, P value = 0.03), a neutrophil percentage greater than 74% (odds ratio of 3.82, P value = 0.03) and serum albumin less than 3 g/L (odds ratio of 5.09, P value = 0.01) were predictors of IVIG resistance. Our study cannot conclude that the three Japanese scoring systems are not suitable for predicting IVIG resistance in the Thai population due to study limitations. However, a high-grade fever (≥ 40.2 °C), neutrophil predominance ≥ 74% and hypoalbuminemia (serum albumin level < 3 g/L) were predictors of IVIG resistance in Thai KD patients.