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Nomogram for predicting coronary artery lesions in patients with Kawasaki disease
Jie Chen1, Jing Li1, Yang-Hua Yue1
1Department of Clinical Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
Insights
This study identifies key risk factors for coronary artery lesions in Kawasaki disease, developing a nomogram to predict their likelihood. This tool aids clinicians in making timely, personalized treatment decisions for affected children.
Area of Science:
- Pediatric Cardiology
- Immunology
- Vascular Biology
Background:
- Kawasaki disease frequently leads to coronary artery lesions, a major cause of long-term cardiovascular issues.
- Untreated patients face a 25-30% risk of developing coronary artery disease.
- These complications can result in significant, lasting cardiovascular sequelae.
Purpose of the Study:
- To identify independent risk factors for coronary artery lesions in Kawasaki disease.
- To develop and validate a predictive nomogram for coronary artery lesion development.
- To enhance clinical decision-making for Kawasaki disease management.
Main Methods:
- Retrospective analysis of 599 patients diagnosed with Kawasaki disease.
- Development of a predictive nomogram using multivariate logistic regression on a training set.
- Validation of the nomogram's predictive performance using calibration curves, AUC, C-index, and DCA on a separate validation set.
Main Results:
- Identified intravenous immunoglobulin (IVIG) resistance, delayed IVIG treatment, C-reactive protein, and neutrophil/lymphocyte ratio as independent risk factors.
- The nomogram demonstrated good predictive accuracy with AUCs of 0.790 (training) and 0.711 (validation).
- Decision curve analysis confirmed the nomogram's significant clinical utility and net benefit.
Conclusions:
- The developed nomogram is a reliable tool for predicting coronary artery lesions in Kawasaki disease patients.
- This predictive model supports timely and individualized clinical interventions.
- The nomogram empowers clinicians to optimize treatment strategies and mitigate cardiovascular risks.
Background:
Coronary artery lesions are the most important complications of Kawasaki disease. Approximately 25-30% of untreated patients develop coronary artery disease, which can lead to long-term cardiovascular sequelae.
Aim:
The aim of this study is to evaluate the risk factors for coronary artery lesions in Kawasaki disease and to construct a nomogram for predicting the likelihood of developing such lesions.
Methods:
Data from 599 patients between January 2012 and June 2020 were reviewed retrospectively. Patients were randomly assigned to the training set (n = 450) and the validation set (n = 149). A comparison of clinical features and laboratory data was performed, followed by multivariate logistic regression analysis to identify independent risk factors and develop the nomogram. The predictive efficiency of the nomogram was evaluated using the calibration curve, area under the receiver operating characteristic curve (AUC), C-index, and decision curve analysis (DCA).
Results:
Intravenous immunoglobulin (IVIG) resistance, delayed IVIG treatment, C-reactive protein, and neutrophil/lymphocyte ratio were identified as independent risk factors for the development of coronary artery lesions. The nomogram was constructed based on these four variables. The calibration curve of the nomogram showed a high degree of agreement between the predicted probability and the actual probability. The AUC of the nomogram in the training and validation set was 0.790 and 0.711, respectively. In addition, DCA revealed that the nomogram provided a significant net benefit, further supporting its clinical utility.
Conclusions:
The constructed nomogram demonstrates a strong and reliable performance in predicting coronary artery lesions, which enables clinicians to make timely and tailored clinical decisions.
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