Objective To investigate the predictive value of thrombospondin-2 (TSP-2) in assessing the response to intravenous immunoglobulin (IVIG) in children with acute Kawasaki disease (KD).
Methods This was a cohort study with controls. 71 children with KD were recruited as the case group, including IVIG non-responder (n=17) and IVIG responder (n=54), and healthy children (n=27) and febrile children (n=30) were used as control groups. ELISA was used to measure plasma TSP-2 and TSP-1 levels. The rank-sum test was used to compare groups of non-normally distributed data. Predictive value was evaluated through the receiver operating characteristic (ROC) curve.
Results Compared with the control groups, the plasma TSP-2 levels in acute KD were significantly elevated (TSP-2: 31.00 (24.02, 39.28) vs 21.93 (17.00, 24.73) vs 16.23 (14.00, 19.64) ng/mL, P<0.001). The plasma TSP-2 level in the IVIG non-responder was significantly higher than the responder group (37.58 (31.86, 43.98) vs 27.84 (21.88, 33.48) ng/mL, P=0.002). When using an ROC curve to analyse the predictive effect of TSP-2 on non-responsiveness to IVIG treatment, the area under the curve was 0.752 (0.630, 0.875) (P=0.002). When the cut-off value for TSP-2 was 31.50 ng/mL, the sensitivity was 82.35%, the specificity was 64.81%.
Conclusion The plasma TSP-2 level was elevated in acute KD and it might be a novel predictor for IVIG resistance, which could help guide clinicians to choose individualised initial therapeutic regimens.
- Kawasaki disease
- immunoglobulin non-response
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Contributors XL obtained funding and designed the study. SY and RS were involved in data collection, verification, analysis and specimen detection. TZ, JF and XC took part in experimental guidance. RS drafted the manuscript and SY revised the paper. XL contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript. XL is the study guarantor.
Funding This work was supported by Research Project for the Application of Clinical Characteristics in Capital (Grant No. Z131107002213035) and Research Fund for Clinical Technology Innovation Project of Beijing Hospital Authority (Grant No. XMLX201612).
Competing interests None declared.
Patient consent Guardian consent obtained.
Ethics approval The Ethics Committee of Children’s Hospital Capital Institute of Pediatrics (No. 2012026).
Provenance and peer review Not commissioned; externally peer reviewed.
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