Kobayashi Score for IVIG Resistance Risk

The Kobayashi score estimates the likelihood of IVIG resistance in Kawasaki disease using seven clinical and laboratory variables 1 [Level I evidence].

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Serum Sodium 133 mmol/L or less?
AST 100 IU/L or greater?
CRP 10 mg/dL or greater?
Neutrophils 80% or greater of WBC?
Platelet count 300,000/mm3 or less?
Fever, even with Dx and Tx before 4th day of illness?
Age 12 months or younger?

사용 적응증

Used in children with acute Kawasaki disease before initial IVIG to estimate risk of IVIG resistance and guide consideration of adjunctive primary therapy (eg, corticosteroids or cyclosporine). High scores identify patients at increased risk for nonresponse, but external validation shows only modest discrimination (summary C‑statistic 0.65) and poor positive predictive value 1 [Level II evidence]. Best applied in East Asian populations; performance is limited elsewhere.

통찰 및 주의사항

Identifies high‑risk Kawasaki disease but performs modestly across populations: meta‑analysis shows C‑statistic ~0.65 with PPV 0.14–0.39 and NPV 0.85–0.92 1 [Level I evidence]. Developed in a single Japanese cohort with stronger accuracy there; overestimates or misclassifies risk in non‑Asian cohorts. Useful to flag possible resistance but not reliable for treatment decisions alone. Clinical judgment and evolving biomarkers remain essential.