Predictive value for intravenous immunoglobulin resistance of Kobayashi and Kawanet scores in 722 children with Kawasaki disease across diverse ethnic backgrounds (KIWI study): an international cohort

12 hours ago

The study evaluates the predictive value of Kobayashi and Kawanet scores for IVIg resistance in Kawasaki disease (KD) across diverse ethnic backgrounds.
IVIg resistance affects 15-25% of children with KD, increasing the risk of coronary artery abnormalities (CAA).
The Kobayashi score has good predictive value in Japanese cohorts but limited accuracy in non-Asian populations.
The Kawanet model was proposed as an alternative with improved applicability in non-Asian settings.
The study included 722 children from diverse ethnic backgrounds (Caucasian, Indian, other Asian, mixed).
IVIg resistance occurred in 19.7% of patients, with the highest rate in mixed-ethnicity patients (33.3%).
Independent predictors of IVIg resistance included prolonged fever, cardiac involvement, musculoskeletal involvement, and macrophage activation syndrome.
The Kobayashi score showed 71% sensitivity and 39% specificity, while the Kawanet score showed 16% sensitivity and 90% specificity.
Both scores performed poorly, highlighting the need for inclusive, biomarker-based, adaptive models.
Future research should focus on larger, more ethnically balanced cohorts and assess structural and sociodemographic determinants.

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