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Development and Validation of a Nomogram for Predicting Intravenous Immunoglobulin-Responsive Coronary Progression in

Xingyue Pu1, Yue Peng2, Xue Zhou2

  • 1Children's Hospital of Chongqing Medical University, Chongqing, China.

The Canadian Journal of Cardiology
|July 10, 2025
PubMed

Insights

This study identifies a Kawasaki disease subgroup that responds to IVIG but still progresses in coronary artery lesions. A new nomogram predicts this risk, enabling early intervention for better outcomes.

Area of Science:

  • Pediatric Cardiology
  • Rheumatology
  • Immunology

Background:

  • Kawasaki disease (KD) poses risks of coronary artery lesions (CAL) in children.
  • Intravenous immunoglobulin (IVIG) is standard treatment, but some patients show IVIG resistance.
  • A subgroup with IVIG responsiveness but persistent CAL progression, termed IVIG-responsive coronary progression (IVIG-RCP), requires targeted intervention.

Purpose of the Study:

  • To identify predictors of IVIG-responsive coronary progression (IVIG-RCP) in Kawasaki disease.
  • To develop a validated tool for early risk stratification and intervention in this specific patient subgroup.

Main Methods:

  • Retrospective analysis of Kawasaki disease patients meeting AHA criteria.
  • Least Absolute Shrinkage and Selection Operator (LASSO) and multivariable logistic regression for predictor selection.
  • Internal validation using bootstrapping and 5-fold cross-validation; performance assessed with ROC, calibration, and decision curves.

Main Results:

  • Six pretreatment predictors identified: age, fever to IVIG interval, CRP, ESR, albumin, and sodium.
  • Developed nomogram demonstrated strong discrimination (0.831) and clinical utility.
  • A web-based calculator was created for real-time IVIG-RCP risk prediction.

Conclusions:

  • A validated nomogram incorporating six pretreatment variables can predict IVIG-responsive coronary progression risk in Kawasaki disease.
  • This tool facilitates early, targeted interventions for improved patient prognosis.
  • Addresses the clinical need for predictive tools in IVIG-responsive but progressing KD patients.
Abstract

Keywords:
Kawasaki diseasecoronary artery progressionintravenous immunoglobulin responsivenessnomogramprediction model

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