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 study

Background: Intravenous immunoglobulin (IVIg) resistance affects 15-25% of children with Kawasaki disease (KD) and increases the risk of coronary artery abnormalities (CAA). The Kobayashi score has shown 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. Methods: A retrospective-prospective, observational, multicentre cohort study including children fulfilling the American Heart Association criteria for KD was conducted. The availability of all clinical and laboratory variables required to calculate both the Kobayashi and Kawanet IVIg-resistance scores was mandatory for inclusion (sodium, neutrophil percentage, AST, platelet count, CRP, age, illness days at first IVIg administration, ALT, hepatomegaly, lymphocyte count, time to treatment). All included patients were aged