A decision tree model for predicting intravenous immunoglobulin resistance and coronary artery involvement in Kawasaki disease

Abstract

OBJECTIVES: This study aims to develop a new algorithm for predicting intravenous immunoglobulin (IVIG) resistance and coronary artery involvement in Kawasaki disease (KD) through decision tree models. METHODS: Medical records of children hospitalized for KD were analysed retrospectively. We compared the clinical characteristics, and the laboratory data in the groups with IVIG resistance and coronary artery dilatations (CADs) in KD patients. The decision tree models were developed to predict IVIG resistance and CADs. RESULTS: A total 896 patients (511 males and 385 females; 1month-12years) were eligible. IVIG resistance was identified in 111 (12.3%) patients, and CADs were found in 156 (17.4%). Total bilirubin and nitrogen terminal- pro-brain natriuretic peptide (NT-proBNP) were significantly higher in IVIG resistant group than in IVIG responsive group (0.62 ± 0.8mg/dL vs 1.38 ± 1.4mg/dL and 1231 ± 2136pg/mL vs 2425 ± 4459mL, respectively,P < 0.01). Also, CADs were more developed in the resistant group (39/111; 14.9% vs. 117/785; 35.1%,P < 0.01). The decision tree for predicting IVIG resistance was classified based on total bilirubin (0.7mg/mL, 1.46mg/dL) and NT-proBNP (1561pg/mL), consisting of two layersand four nodes, with 86.2% training accuracy and 90.5% evaluation accuracy. The Receiver Operating Characteristic (ROC) evaluated the predictive ability of the decision tree, and the area under the curve (AUC) (0.834; 95% confidence interval, 0.675-0.973;P < 0.05) showed relatively higher accuracy. The group with CADs had significantly higher total bilirubin and NT-proBNP levels than the control group (0.64 ± 0.82mg/dL vs 1.04 ± 1.14mg/dL and 1192 ± 2049pg/mL vs 2268 ± 4136pg/mL, respectively,P < 0.01). The decision trees for predicting CADs were classified into two nodes based on NT-proBNP (789pg/mL) alone, with 83.5% training accuracy and 90.3% evaluation accuracy. CONCLUSION: A new algorithm decision tree model presents for predicting IVIG resistance and CADs in KD, confirming the usefulness of NT-proBNP as a predictor of KD.