Complement 3 and Prognostic Nutritional Index Distinguish Kawasaki Disease from Fever Illness with Nomogram

Abstract Objective: This study aimed to establish a model to distinguish Kawasaki diseases(KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 KD and 494 children with febrile diseases). Of those, 415 patients were selected to be the training group and 277 patients to be the validation group. Laboratory data, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and immunological factors, were retrospectively collected for analysis after admission. We used univariate and multivariate logistic regression and nomogram for analysis. Result: Patients with KD showed significantly higher C3 and lower PNI. After multivariate logistic regression, total leukocyte count, PNI, C3, and NLR showed significance (p<0.05) and then performed well with the nomogram model. The areas under the ROC in the training group and the validation group were 0.858 and 0.825, respectively. The calibration curves of the two groups for the probability of KD showed near agreement to the actual probability. Conclusion: Compared to children with febrile diseases, patients with KD showed increased C3 and decreased nutritional index of PNI. The nomogram established with these factors can effectively identify KD from febrile illness in children.