Comparison of risk scoring systems to predict IVIg resistance in Kawasaki disease in Chonburi Hospital

Abstract

Background: Coronary artery aneurysm is a major complication of Kawasaki disease (KD). Patients resistant to intravenous immunoglobulin (IVIg) therapy are at increased risk of developing this complication. Several scoring systems have been developed to assess risk and guide treatment adjustments to reduce adverse outcomes.

Objectives: To compare the sensitivity and specificity of the Kobayashi score and the Las Vegas Scoring System (LVSS) in predicting IVIg resistance among patients with KD at Chonburi Hospital, and to identify factors associated with this condition.

Methods: This retrospective study included 142 patients with KD admitted to Chonburi Hospital who received at least one dose of IVIg between March 1, 2018, and March 31, 2025. Demographic, clinical, and laboratory data were analyzed using independent t-tests and chi-square tests. Predictive performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). Multivariable logistic regression was used to identify factors associated with IVIg resistance.

Results: The Kobayashi score demonstrated higher sensitivity (42.9% vs. 38.1%), specificity (89.3% vs. 74.4%), PPV (40.9% vs. 20.5%), and NPV (90.0% vs. 87.4%) than LVSS. The AUCs were 0.670 and 0.638, respectively, with no significant difference (p value 0.703). Rash was independently associated with IVIg resistance (adjusted OR 9.50; p value 0.009).

Conclusions: Both scoring systems showed comparable, moderate predictive performance. Despite relatively high specificity, low sensitivity limits their use as standalone screening tools. Combining these systems with clinical and laboratory parameters may improve prediction of IVIg resistance in Thai pediatric patients with KD.