Predictive value of coagulation profiles for both initial and repeated
immunoglobulin resistance in Kawasaki disease: a prospective cohort
study
Abstract
Background: Intravenous immunoglobulin (IVIG) resistance prediction
remains substantial in Kawasaki disease (KD), with limited data on the
predictive value of coagulation profile for IVIG resistance,
particularly for repeated IVIG resistance. Therefore, the aim of our
study was to testify the predictive validity of coagulation profile for
both initial and repeated IVIG resistance in KD. Methods: A total of 385
KD patients were prospectively recruited between April in 2015 and May
in 2019. Coagulation and other profiles were evaluated between
IVIG-responsive and IVIG-resistant groups. Multivariate logistic
regression analysis was applied to determine the association between
coagulation profiles and IVIG resistance. ROC curves analysis was
further performed to assess validity of coagulation profiles in
predicting both initial and repeated IVIG resistance. Results: PT, APTT
and D-dimer were significantly increased in initial IVIG-resistant group
with ATIII significantly reduced. Meanwhile, ATIII was declined markedly
in repeated IVIG-resistant patients. PT, APTT, D-dimer and ATIII cutoff
values of 13.95 s, 41.15 s, 1.48 mg/l, and 89.5% yielded sensitivities
of 73%, 32%, 71%, 81%; specificities of 55%, 88%, 62%, 51% for
predicting initial IVIG resistance, respectively. The cutoff value of
ATIII for predicting repeated IVIG resistance was 68.5%, with
sensitivity of 71% and specificity of 55%. Multivariate logistic
regression analysis showed that PT, APTT, D-dimer and ATIII were
independent risk factors for initial IVIG resistant patients with KD.
Conclusions: Coagulation profiles were significantly dysregulated in KD
patients. Some of them particularly ATIII may serve as complementary
laboratory markers for prediction of both initial and repeated IVIG
resistance.