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Liu XP, Huang YS, Kuo HC, Xia HB, Yi-Sun, Huang WD, Lang XL, Liu CY, Liu X. A novel nomogram model for differentiating Kawasaki disease from sepsis. Sci Rep 2020; 10:13745. [PMID: 32792679 PMCID: PMC7427092 DOI: 10.1038/s41598-020-70717-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) is a form of systemic vasculitis that occurs in children under the age of 5 years old. Due to prolonged fever and elevated inflammatory markers that are found in both KD and sepsis, the treatment approach differs for each. We enrolled a total of 420 children (227 KD and 193 sepsis) in this study. Logistic regression and a nomogram model were used to analyze the laboratory markers. We randomly selected 247 children as the training modeling group and 173 as the validation group. After completing a logistic regression analysis, white blood cell (WBC), anemia, procalcitonin (PCT), C-reactive protein (CRP), albumin, and alanine transaminase (ALT) demonstrated a significant difference in differentiating KD from sepsis. The patients were scored according to the nomogram, and patients with scores greater than 175 were placed in the high-risk KD group. The area under the curve of the receiver operating characteristic curve (ROC curve) of the modeling group was 0.873, sensitivity was 0.893, and specificity was 0.746, and the ROC curve in the validation group was 0.831, sensitivity was 0.709, and specificity was 0.795. A novel nomogram prediction model may help clinicians differentiate KD from sepsis with high accuracy.
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Shuang Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, #123, Dapei Rd., Niaosong, Kaohsiung, 83301, Taiwan
| | - Han-Bing Xia
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Sun
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Wei-Dong Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Xin-Ling Lang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Chun-Yi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
| | - Xi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
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Liu XP, Huang YS, Xia HB, Sun Y, Lang XL, Li QZ, Liu CY, Kuo HC, Huang WD, Liu X. A Nomogram Model Identifies Eosinophilic Frequencies to Powerfully Discriminate Kawasaki Disease From Febrile Infections. Front Pediatr 2020; 8:559389. [PMID: 33363059 PMCID: PMC7759494 DOI: 10.3389/fped.2020.559389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Kawasaki disease (KD) is a form of systemic vasculitis that occurs primarily in children under the age of 5 years old. No single laboratory data can currently distinguish KD from other febrile infection diseases. The purpose of this study was to establish a laboratory data model that can differentiate between KD and other febrile diseases caused by an infection in order to prevent coronary artery complications in KD. Methods: This study consisted of a total of 800 children (249 KD and 551 age- and gender-matched non-KD febrile infection illness) as a case-control study. Laboratory findings were analyzed using univariable, multivariable logistic regression, and nomogram models. Results: We selected 562 children at random as the model group and 238 as the validation group. The predictive nomogram included high eosinophil percentage (100 points), high C-reactive protein (93 points), high alanine transaminase (84 points), low albumin (79 points), and high white blood cell (64 points), which generated an area under the curve of 0.873 for the model group and 0.905 for the validation group. Eosinophilia showed the highest OR: 5.015 (95% CI:-3.068-8.197) during multiple logistic regression. The sensitivity and specificity in the validation group were 84.1 and 86%, respectively. The calibration curves of the validation group for the probability of KD showed near an agreement to the actual probability. Conclusion: Eosinophilia is a major factor in this nomogram model and had high precision for predicting KD. This report is the first among the existing literature to demonstrate the important role of eosinophil in KD by nomogram.
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yi-Shuang Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Han-Bing Xia
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yi Sun
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Xin-Ling Lang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Qiang-Zi Li
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Chun-Yi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Ho-Chang Kuo
- Department of Pediatrics, Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Dong Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Xi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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Boodoosingh N, Seecheran R, Varachhia S, Mack N, Minocha V, Giddings S, Seecheran NA. Incomplete Kawasaki Disease in an Adult South Asian Patient. J Investig Med High Impact Case Rep 2018; 6:2324709618792028. [PMID: 30057925 PMCID: PMC6058420 DOI: 10.1177/2324709618792028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 12/01/2022] Open
Abstract
Kawasaki disease is an acute multisystemic vasculitis occurring predominantly in children and rarely in adults, with sequelae of potentially life-threatening coronary artery aneurysms. “Incomplete” Kawasaki disease is a novel concept and considered a diagnosis of exclusion as it alludes to patients with fever lasting ⩾5 days and 2 or 3 clinical criteria without another reasonable explanation for the illness. The multidisciplinary team should be vigilant for this oligosymptomatic clinical presentation, specifically within this subgroup despite age and ethnicity, and the syndrome should be considered as a differential diagnosis in challenging cases presenting as infectious or autoimmune disease.
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Affiliation(s)
- Neetu Boodoosingh
- South West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Rajeev Seecheran
- South West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Saleem Varachhia
- South West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Narine Mack
- South West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Vinay Minocha
- South West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Stanley Giddings
- University of the West Indies, St Augustine, Trinidad and Tobago
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