O2051: Diagnostic Accuracy of Procalcitonin in Identifying Intravenous Immunoglobulin Resistance in Children with Kawasaki Disease: A Systemic Review and Meta-analysis

Background: Kawasaki Disease (KD) is a systemic illness that affects children in which a specific diagnostic test does not exist. Treatment includes Intravenous Immunoglobulin (IVIG) however, ~10-20% are unresponsive and are at a higher risk of developing coronary artery lesions (CALs). The objective of this study is to investigate the diagnostic accuracy of procalcitonin (PCT) in identifying IVIG resistance in children with KD.

Methods: Electronic databases including PubMed, Biomed Central, Scopus, PLOS, Herdin, ScienceDi-rect, and Google Scholar were searched without limitations to time, location, and language. Four studies with a total of 902 participants were included. Sensitivity and specificity with 95% confidence intervals were estimated and combined sensitivity and specificity were calculated for all included studies. Random-effects bivariate meta-regression models were used to do the summary receiver operating characteristics (SROC) curve for the pooled estimate.

Results: The pooled specificity and sensitivity of PCT in diagnosing IVIG resistance in children with KD are 73.93% (95% CI=54.54% to 87.02%) and 64.79% (95% CI=44.40% to 80.92%), re-spectively, with a positive likelihood ratio (LR) of 2.49 and a negative LR of 0.48. The area un-der the curve revealed a 0.75 (95% CI= 0.7 to 0.78) representing fair diagnostic accuracy in predicting IVIG resistance among children with KD. However, due to the high heterogeneity between studies, which could not be explored through subgroup analysis because of the small number of included studies, further research is recommended.

Conclusion: Procalcitonin can be a marker for IVIG resistance in KD children but must be interpreted in context with clinical and other laboratory parameters.