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Authors: Ying Dong, Shaojie Chen
Journal: JAMA Pediatrics (2017)

corroborated by multivariable regression analyses, although individual patient-level data are not available. 4,5 Four of 16 studies enrolled patients with CAA at baseline (a subgroup with more severe disease). 4Among these studies, the mean time of initiation of corticosteroids ranged from 6 to 9 days after illness onset, and notably, all demonstrated a nonsignificant role of add-on corticosteroids in preventing CAA. 4 If the major merit of corticosteroid therapy for KD is derived from an early suppression of vessel inflammation prior to vascular remodeling, it is possible that any delay in the initiation of therapy would likely raise the risk of CAA.In reviewing published data, there are several scoring systems used for the prediction of intravenous immunoglobulin resistance. 4 Despite the good performance in early identification of high-risk patients among Asian populations, their predictive ability in non-Asian populations seemed suboptimal.Future studies to develop risk scores in non-Asian patient groups are warranted.In consideration of the literature's relevance and quality in the process of study inclusion, we focused on 3 medical databases (Medline, The Cochrane Library, and Clinicaltrials.gov) to perform literature searching.Regarding individual study quality and bias, we evaluated the methodological quality of the included studies, and all included studies were considered medium to high quality (published in the online Supplement 4 ).Estimation for publication bias further indicated a low risk of bias (Begg test P = .56and Egger test P = .25). 4 García-Perdomo and Calle reanalyzed our data by using Stata software, and their result showed an even stronger magnitude of the effect favoring the addition of corticosteroids in treating KD.However, after a second statistical analysis, our statistical values are consistent using both Revman, version 5.3 (Cochrane Community) and Comprehensive Meta-Analysis, version 2.2 (BioStat) software (overall meta-analysis for incidence of CAA between corticosteroids group and intravenous immunoglobulin group: odds ratio, 0.42; 95% CI, 0.27-0.67;P <.001, randomeffects model).Our subgroup analyses further showed that the significant effect of corticosteroids in CAA prevention was maintained in the nonrandomized subgroup analysis (odds ratio, 0.54; 95% CI, 0.319-0.914;P = .02,random-effects model), and an even more pronounced effect was observed in the randomized subgroup analysis (odds ratio, 0.321; 95% CI, 0.146-0.706;P = .005,random-effects model).This subgroup analysis is in line with the results of a previously published study. 2 Although our pooled analyses revealed significant results, there was heterogeneity among included studies in patients' demographic characteristics, socioeconomic environment, standard of care in each individual institution, physicians' awareness and experience, and availability of medical resources.All of these factors can play an important part in clinical decision making but could not be accounted for during the process of data pooling. 4,5 The results produced by pooled analyses, therefore, may not be applicable in all clinical settings without regard to the specific circumstance of individual patients.