Nomogram for predicting the risk of coronary artery lesions in patients with Kawasaki disease based on anti-neutrophil cytoplasmic antibodies

doi:10.3969/j.issn.1674-8115.2025.04.008

Abstract

Abstract:

Objective ·To evaluate the predictive value of anti-neutrophil cytoplasmic antibodies (ANCA) in Kawasaki disease (KD) complicated with coronary artery lesions (CALs) and to construct a nomogram prediction model. Methods ·A retrospective study was conducted to collect the clinical data of 340 children with KD admitted to Shanghai Children's Medical Center from January 2018 to May 2024. All patients were randomly divided in a 7:3 ratio into a training set (n=237) and a validation set (n=103). Univariate analysis and least absolute shrinkage and selection operator (LASSO) were applied to screen the risk factors of CALs, which were incorporated into multifactorial Logistic regression analysis to develop the nomogram model. The model's discrimination, calibration and clinical practicability were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA). A new predictive scoring system was obtained by assigning scores to each variable based on the coefficients of the independent variables in the Logistic regression equation, and its predictive efficacy was then compared with that of three commonly used scoring systems, Kobayashi, Egami, and Sano scoring models. Results ·Male, low serum albumin level, ANCA positivity, and intravenous immunoglobulin resistance were risk factors for the development of CALs in children with KD, based on which a nomogram model was constructed. The area under the ROC curve for the nomogram in the training set and validation set were 0.747 (95%CI 0.667‒0.821) and 0.645 (95%CI 0.500‒0.794), respectively, indicating good effectiveness. The model was verified to have good predictive accuracy through the calibration curve and Hosmer-Lemeshow goodness-of-fit test (training set: χ²=5.105, P=0.746; validation set:χ²=13.549, P=0.094). The DCA showed its clinical usefulness. A predictive scoring system for CALs was developed based on the coefficients of the Logistic regression equation, which demonstrated higher sensitivity (58.4%) and specificity (78.7%) compared to the Kobayashi, Egami, and Sano scoring models. Conclusion ·This study developed a new scoring model based on ANCA to effectively predict the risk of CALs in KD patients. The model provides valuable reference for clinicians to identify high-risk patients early, and to formulate personalized treatment plans and management strategies.

Key words: Kawasaki disease, coronary artery lesion, anti-neutrophil cytoplasmic antibody, nomogram, prediction model

CLC Number:

R725.4

CHEN Rong, ZHANG Meng, ZHU Diqi, GUO Ying, SHEN Jie. Nomogram for predicting the risk of coronary artery lesions in patients with Kawasaki disease based on anti-neutrophil cytoplasmic antibodies[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 459-467.

Figures/Tables 10

TrendMD

References 32

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Variable	Training set (n=237)			Validation set (n=103)				P value^①
Variable	CAL (n=58)	NCAL (n=179)	P value		CAL (n=19)	NCAL (n=84)	P value	P value^①
Gender/n(%)			<0.001				0.682	0.897
Male	45 (77.59)	85 (47.49)		12 (63.16)		46 (54.76)
Female	13 (22.41)	94 (52.51)		7 (36.84)		38 (45.24)
Age/month	30.00 (12.25,47.50)	33.00 (18.00,56.50)	0.148	29.00 (15.00,49.50)		31.00 (18.75,52.50)	0.702	0.781
Fever duration before IVIG/n(%)			0.228				0.316	0.941
<5 d	13 (22.41)	26 (14.53)		5 (26.32)		13 (15.48)
≥5 d	45 (77.59)	153 (85.47)		14 (73.68)		71 (84.52)
CRP/(mg·L^-1)	64.80 (37.95,103.03)	63.40 (34.90,95.10)	0.601	81.70 (51.60,109.70)		61.60 (39.78,101.92)	0.161	0.420
NEUT%/%	66.26 (55.21,76.89)	65.70 (53.70,76.78)	0.895	68.21 (55.82,80.45)		67.32 (52.11,74.67)	0.280	0.933
HGB/(g·L^-1)	107.00 (101.00,115.00)	110.00 (103.00,117.00)	0.209	107.00 (101.00,112.50)		110.50 (102.75,116.00)	0.139	0.462
PLT/(×10⁹·L^-1)	332.00 (227.50,452.50)	336.00 (259.00,416.00)	0.702	253.00 (219.50,338.00)		329.50 (262.75,417.00)	0.038	0.170
Na⁺/(mmol·L^-1)	135.60 (134.00,137.25)	137.00 (135.00,138.65)	0.010	136.00 (133.80,137.55)		136.55 (135.00,138.15)	0.190	0.922
ESR/(mm·h^-1)	65.50 (44.75,75.00)	65.00 (48.00,81.00)	0.531	66.00 (54.50,74.00)		71.00 (54.50,87.00)	0.655	0.120
Ferr/(ng·mL^-1)	171.25 (110.67,270.36)	175.52 (130.20,241.20)	0.712	252.60 (152.65,291.90)		167.55 (136.88,272.72)	0.241	0.177
ALT/(IU·L^-1)	27.50 (18.00,48.75)	24.00 (15.50,59.50)	0.356	30.00 (20.00,134.50)		28.00 (18.75,60.00)	0.540	0.215
AST/(IU·L^-1)	33.00 (27.00,47.75)	33.00 (28.00,46.50)	0.731	33.00 (28.00,70.00)		34.00 (26.00,42.50)	0.507	0.579
ALB/(g·L^-1)	34.62±4.36	3 6.66±3.98	0.002	35.22±2.87		36.04±4.59	0.326	0.586
TBIL/(μmol·L^-1)	8.80 (6.12,12.15)	8.20 (5.60,11.45)	0.352	9.10 (4.85,24.05)		8.75 (6.65,11.72)	0.953	0.264
NT-proBNP/(pg·mL^-1)	652.00 (185.50,2460.25)	302.00 (104.00,984.00)	0.014	291.00 (94.50,1528.50)		406.00 (186.50,1189.75)	0.792	0.691
IL-6/(pg·mL^-1)	74.51 (25.09,246.56)	71.00 (33.11,169.65)	0.402	74.39 (35.95,150.71)		80.64 (24.84,167.78)	0.875	0.905
Count of CD3⁺CD4⁺/n	1 173.84 (694.43,1 779.17)	1 183.81 (635.24,2 016.62)	0.857	862.66 (396.05,1 269.99)		1 110.01 (670.87,2 006.53)	0.208	0.724
ANA/n(%)			0.934				0.547	1.000
Positive	12 (20.69)	40 (22.35)		5 (26.32)		17 (20.24)
Negative	46 (79.31)	139 (77.65)		14 (73.68)		67 (79.76)
ANCA/n(%)			0.007				0.002	0.946
Positive	8 (13.79)	6 (3.35)		5 (36.32)		2 (2.38)
Negative	50 (86.21)	173 (96.65)		14 (73.68)		82 (97.62)
IVIG resistance/n(%)			0.008				0.031	0.846
Yes	14 (24.14)	17 (9.50)		6 (31.58)		9 (10.71)
No	44 (75.86)	162 (90.50)		13 (68.42)		75 (89.29)

Variable	Training set (n=237)			Validation set (n=103)				P value^①
Variable	CAL (n=58)	NCAL (n=179)	P value		CAL (n=19)	NCAL (n=84)	P value	P value^①
Gender/n(%)			<0.001				0.682	0.897
Male	45 (77.59)	85 (47.49)		12 (63.16)		46 (54.76)
Female	13 (22.41)	94 (52.51)		7 (36.84)		38 (45.24)
Age/month	30.00 (12.25,47.50)	33.00 (18.00,56.50)	0.148	29.00 (15.00,49.50)		31.00 (18.75,52.50)	0.702	0.781
Fever duration before IVIG/n(%)			0.228				0.316	0.941
<5 d	13 (22.41)	26 (14.53)		5 (26.32)		13 (15.48)
≥5 d	45 (77.59)	153 (85.47)		14 (73.68)		71 (84.52)
CRP/(mg·L^-1)	64.80 (37.95,103.03)	63.40 (34.90,95.10)	0.601	81.70 (51.60,109.70)		61.60 (39.78,101.92)	0.161	0.420
NEUT%/%	66.26 (55.21,76.89)	65.70 (53.70,76.78)	0.895	68.21 (55.82,80.45)		67.32 (52.11,74.67)	0.280	0.933
HGB/(g·L^-1)	107.00 (101.00,115.00)	110.00 (103.00,117.00)	0.209	107.00 (101.00,112.50)		110.50 (102.75,116.00)	0.139	0.462
PLT/(×10⁹·L^-1)	332.00 (227.50,452.50)	336.00 (259.00,416.00)	0.702	253.00 (219.50,338.00)		329.50 (262.75,417.00)	0.038	0.170
Na⁺/(mmol·L^-1)	135.60 (134.00,137.25)	137.00 (135.00,138.65)	0.010	136.00 (133.80,137.55)		136.55 (135.00,138.15)	0.190	0.922
ESR/(mm·h^-1)	65.50 (44.75,75.00)	65.00 (48.00,81.00)	0.531	66.00 (54.50,74.00)		71.00 (54.50,87.00)	0.655	0.120
Ferr/(ng·mL^-1)	171.25 (110.67,270.36)	175.52 (130.20,241.20)	0.712	252.60 (152.65,291.90)		167.55 (136.88,272.72)	0.241	0.177
ALT/(IU·L^-1)	27.50 (18.00,48.75)	24.00 (15.50,59.50)	0.356	30.00 (20.00,134.50)		28.00 (18.75,60.00)	0.540	0.215
AST/(IU·L^-1)	33.00 (27.00,47.75)	33.00 (28.00,46.50)	0.731	33.00 (28.00,70.00)		34.00 (26.00,42.50)	0.507	0.579
ALB/(g·L^-1)	34.62±4.36	3 6.66±3.98	0.002	35.22±2.87		36.04±4.59	0.326	0.586
TBIL/(μmol·L^-1)	8.80 (6.12,12.15)	8.20 (5.60,11.45)	0.352	9.10 (4.85,24.05)		8.75 (6.65,11.72)	0.953	0.264
NT-proBNP/(pg·mL^-1)	652.00 (185.50,2460.25)	302.00 (104.00,984.00)	0.014	291.00 (94.50,1528.50)		406.00 (186.50,1189.75)	0.792	0.691
IL-6/(pg·mL^-1)	74.51 (25.09,246.56)	71.00 (33.11,169.65)	0.402	74.39 (35.95,150.71)		80.64 (24.84,167.78)	0.875	0.905
Count of CD3⁺CD4⁺/n	1 173.84 (694.43,1 779.17)	1 183.81 (635.24,2 016.62)	0.857	862.66 (396.05,1 269.99)		1 110.01 (670.87,2 006.53)	0.208	0.724
ANA/n(%)			0.934				0.547	1.000
Positive	12 (20.69)	40 (22.35)		5 (26.32)		17 (20.24)
Negative	46 (79.31)	139 (77.65)		14 (73.68)		67 (79.76)
ANCA/n(%)			0.007				0.002	0.946
Positive	8 (13.79)	6 (3.35)		5 (36.32)		2 (2.38)
Negative	50 (86.21)	173 (96.65)		14 (73.68)		82 (97.62)
IVIG resistance/n(%)			0.008				0.031	0.846
Yes	14 (24.14)	17 (9.50)		6 (31.58)		9 (10.71)
No	44 (75.86)	162 (90.50)		13 (68.42)		75 (89.29)

Variable	B	SE	P value	OR	95%CI
Male	-1.259	0.362	0.001	0.283	0.135‒0.564
ALB	-0.115	0.041	0.005	0.891	0.820‒0.964
ANCA	1.292	0.620	0.037	3.639	1.078‒12.740
IVIG resistance	0.653	0.437	0.135	1.922	0.800‒4.496

Variable	B	SE	P value	OR	95%CI
Male	-1.259	0.362	0.001	0.283	0.135‒0.564
ALB	-0.115	0.041	0.005	0.891	0.820‒0.964
ANCA	1.292	0.620	0.037	3.639	1.078‒12.740
IVIG resistance	0.653	0.437	0.135	1.922	0.800‒4.496

Variable	B	SE	P value	OR	95%CI	Score
Male	-0.972	0.299	0.001	0.378	0.206‒0.670	5
ALB<35 g·L^-1	0.687	0.279	0.014	1.986	1.149‒3.441	3
ANCA positivity	1.550	0.507	0.002	4.711	1.758‒13.140	8
IVIG resistance	0.792	0.365	0.030	2.208	1.064‒4.481	4