European journal of pediatrics · 2026
A nomogram for predicting Kawasaki Disease in acutely febrile children with liver injury.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Yang Pingping, Wang Guina, Guo Jing, Yan Wenlong, Xu Lingfen, Meng Lingzhe
Аннотация
UNLABELLED: Liver injury is a common but nonspecific feature of acute Kawasaki disease (KD), often obscuring the diagnosis and delaying treatment. This study aimed to develop and validate a nomogram to predict KD risk in febrile children with liver injury. We conducted a retrospective study of children admitted with fever and liver injury between January 2019 and December 2024. A nomogram was developed using multivariable logistic regression in a training cohort, internally validated, and further evaluated in an independent temporal validation cohort (January-September 2025). Among 1,031 children, KD was the second most common specific diagnosis (13.4%). Nine independent predictors were identified: duration of fever, absolute neutrophil count, absolute lymphocyte count, C-reactive protein, albumin, gamma-glutamyl transferase, total bilirubin, high-density lipoprotein, and serum potassium. The nomogram demonstrated excellent discrimination, with AUCs of 0.983 (training test), 0.962 (internal test), and 0.996 (temporal validation). Calibration and decision-curve analyses confirmed clinical utility.
CONCLUSION: We constructed and validated a robust nomogram using accessible clinical variables. As a supplementary risk-assessment tool, it is designed to raise clinical suspicion of KD in febrile children with liver injury, thereby facilitating earlier intervention and optimized management.
WHAT IS KNOWN: • Liver injury, a common complication of Kawasaki disease (KD), closely correlates with greater inflammation, intravenous immunoglobulin (IVIG) resistance, and higher coronary risk. • No specific predictive tool exists to identify KD among febrile children presenting with liver injury.
WHAT IS NEW: • This study developed and validated the first nomogram to predict KD risk in febrile children with liver injury, using nine clinical parameters. • The model demonstrates excellent performance in both internal and prospective temporal validation. • It highlights low high-density lipoprotein (HDL) as a novel biomarker, useful not only for early diagnosis but also for monitoring acute inflammation in KD.
CONCLUSION: We constructed and validated a robust nomogram using accessible clinical variables. As a supplementary risk-assessment tool, it is designed to raise clinical suspicion of KD in febrile children with liver injury, thereby facilitating earlier intervention and optimized management.
WHAT IS KNOWN: • Liver injury, a common complication of Kawasaki disease (KD), closely correlates with greater inflammation, intravenous immunoglobulin (IVIG) resistance, and higher coronary risk. • No specific predictive tool exists to identify KD among febrile children presenting with liver injury.
WHAT IS NEW: • This study developed and validated the first nomogram to predict KD risk in febrile children with liver injury, using nine clinical parameters. • The model demonstrates excellent performance in both internal and prospective temporal validation. • It highlights low high-density lipoprotein (HDL) as a novel biomarker, useful not only for early diagnosis but also for monitoring acute inflammation in KD.