{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:58:27Z","timestamp":1788350307238,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"publisher","award":["2021YFC2702000"],"award-info":[{"award-number":["2021YFC2702000"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271838"],"award-info":[{"award-number":["82271838"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Project of the Jiangsu Provincial Health Commission","award":["M2021080"],"award-info":[{"award-number":["M2021080"]}]},{"name":"Project of the Jiangsu Provincial Health Commission","award":["M2022018"],"award-info":[{"award-number":["M2022018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kawasaki disease shock syndrome (KDSS), a severe and uncommon phenomenon, lacks effective predictive models for early identification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to establish a new predictive model for KDSS using machine learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Single-center, retrospective analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data of 746 children with KD admitted between July 2021 and June 2023 were collected including demographics, laboratory test results before intravenous immunoglobulin, and echocardiography results. Data were divided into training and testing sets in a 7:3 ratios. After feature engineering, predictive models were built using random forest (RF), logistic regression (LR) and Light Gradient Boosting Machine (LightGBM). Model performance was evaluated using area under the receiver operating characteristic curve (AUC), confusion matrix, average accuracy from 5-fold cross-validation, while also analyzing misclassified cases. A simple early prediction tool was created based on the optimal model. Prospective data from five KDSS patients admitted between January and June 2024 and that of 15 randomly selected non-shock KD patients were used for external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Neutrophil-to-lymphocyte (NLR) ratio had the greatest impact on the model and was an important predictive factor for KDSS, followed by CD3+ lymphocyte percentage (CD3+%)\u00a0and Interleukin-6 (IL-6). The LightGBM model performed best (AUC, 0.9388; average accuracy, 0.9675; 95% CI, 0.9612, 0.9737). Nine patients were misclassified (4.02%). RF and LR models showed slightly lower performance than the LightGBM model (prospective validation AUC, 0.9000; accuracy, 0.8500).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We constructed an early prediction model for KDSS and performed preliminary validation. This web-based prediction tool may assist clinicians in identifying high-risk pediatric patients to enhance monitoring\/treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/qjmed\/hcaf180","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:51:30Z","timestamp":1754567490000},"page":"902-911","source":"Crossref","is-referenced-by-count":2,"title":["Predicting shock syndrome in Kawasaki disease: a machine learning model for enhanced diagnosis"],"prefix":"10.1093","volume":"118","author":[{"given":"Yifeng","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]},{"name":"Department of Pediatrics, Huzhou Central Hospital , Huzhou,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingzhi","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhidan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiguo","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Children\u2019s Hospital of Nanjing Medical University , Nanjing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"2026021212221198300_hcaf180-B1","doi-asserted-by":"crossref","first-page":"e927\u201399","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association","volume":"135","author":"McCrindle","year":"2017","journal-title":"Circulation"},{"key":"2026021212221198300_hcaf180-B2","doi-asserted-by":"crossref","first-page":"e38998","DOI":"10.1371\/journal.pone.0038998","article-title":"Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study","volume":"7","author":"Orenstein","year":"2012","journal-title":"PLoS One"},{"key":"2026021212221198300_hcaf180-B3","doi-asserted-by":"crossref","first-page":"e783\u20139","DOI":"10.1542\/peds.2008-1871","article-title":"Recognition of a Kawasaki disease shock syndrome","volume":"123","author":"Kanegaye","year":"2009","journal-title":"Pediatrics"},{"key":"2026021212221198300_hcaf180-B4","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1097\/INF.0b013e31829efae6","article-title":"Population-based study of Kawasaki disease shock syndrome in Taiwan","volume":"32","author":"Lin","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"2026021212221198300_hcaf180-B5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jmii.2013.06.005","article-title":"Clinical manifestations of Kawasaki disease shock syndrome: a case-control study","volume":"48","author":"Chen","year":"2015","journal-title":"J Microbiol Immunol Infect"},{"key":"2026021212221198300_hcaf180-B6","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1111\/ped.13614","article-title":"Kawasaki disease shock syndrome: unique and severe subtype of Kawasaki disease","volume":"60","author":"Gamez-Gonzalez","year":"2018","journal-title":"Pediatr Int"},{"key":"2026021212221198300_hcaf180-B7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00431-012-1879-1","article-title":"Clinical manifestations associated with Kawasaki disease shock syndrome in Mexican children","volume":"172","author":"G\u00e1mez-Gonz\u00e1lez","year":"2013","journal-title":"Eur J Pediatr"},{"key":"2026021212221198300_hcaf180-B8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1126\/science.aaa8415","article-title":"Machine learning: trends, perspectives, and prospects","volume":"349","author":"Jordan","year":"2015","journal-title":"Science"},{"key":"2026021212221198300_hcaf180-B9","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12916-018-1122-7","article-title":"From hype to reality: data science enabling personalized medicine","volume":"16","author":"Fr\u00f6hlich","year":"2018","journal-title":"BMC Med"},{"key":"2026021212221198300_hcaf180-B10","doi-asserted-by":"crossref","first-page":"108986","DOI":"10.1016\/j.intimp.2022.108986","article-title":"Predictive role of sampling-time specific prognostic nutritional index cut-off values for intravenous immunoglobulin resistance and cardiovascular complications in Kawasaki disease","volume":"110","author":"Liu","year":"2022","journal-title":"Int Immunopharmacol"},{"key":"2026021212221198300_hcaf180-B11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13052-024-01597-x","article-title":"Risk factors and an early predictive model for Kawasaki disease shock syndrome in Chinese children","volume":"50","author":"Zhang","year":"2024","journal-title":"Ital J Pediatr"},{"key":"2026021212221198300_hcaf180-B12","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.echo.2016.03.017","article-title":"A new Z score curve of the coronary arterial internal diameter using the Lambda-Mu-Sigma method in a pediatric population","volume":"29","author":"Kobayashi","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"2026021212221198300_hcaf180-B13","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1093\/aje\/kwad061","article-title":"Using LASSO regression to estimate the population-level impact of pneumococcal conjugate vaccines","volume":"192","author":"Wong","year":"2023","journal-title":"Am J Epidemiol"},{"key":"2026021212221198300_hcaf180-B14","first-page":"4768","article-title":"A unified approach to interpreting model predictions","volume":"30","author":"Lundberg","year":"2017","journal-title":"Adv Neural Inf Process Syst"},{"key":"2026021212221198300_hcaf180-B15","doi-asserted-by":"crossref","first-page":"736352","DOI":"10.3389\/fcvm.2021.736352","article-title":"Clinical features in children with Kawasaki disease shock syndrome: a systematic review and meta-analysis","volume":"8","author":"Zheng","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2026021212221198300_hcaf180-B16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12887-020-02488-w","article-title":"Clinical aspects for differential diagnosis of kawasaki disease shock syndrome: a case control study","volume":"21","author":"Park","year":"2021","journal-title":"BMC Pediatr"},{"key":"2026021212221198300_hcaf180-B17","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1038\/s41390-019-0668-1","article-title":"Shock and unresponsiveness to repeated courses of intravenous immunoglobulin in Kawasaki disease: a nationwide database study","volume":"87","author":"Liang","year":"2020","journal-title":"Pediatr Res"},{"key":"2026021212221198300_hcaf180-B18","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jpeds.2020.12.002","article-title":"Kawasaki disease shock syndrome versus septic shock: early differentiating features despite overlapping clinical profiles","volume":"231","author":"Power","year":"2021","journal-title":"J Pediatr"},{"key":"2026021212221198300_hcaf180-B19","doi-asserted-by":"crossref","first-page":"1400046","DOI":"10.3389\/fimmu.2024.1400046","article-title":"Predicting Kawasaki disease shock syndrome in children","volume":"15","author":"Zhao","year":"2024","journal-title":"Front Immunol"},{"key":"2026021212221198300_hcaf180-B20","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00134-012-2473-8","article-title":"Kawasaki disease: an unexpected etiology of shock and multiple organ dysfunction syndrome","volume":"38","author":"Gatterre","year":"2012","journal-title":"Intensive Care Med"},{"key":"2026021212221198300_hcaf180-B21","doi-asserted-by":"crossref","first-page":"108396","DOI":"10.1016\/j.intimp.2021.108396","article-title":"Atlas of circulating immune cells in Kawasaki disease","volume":"102","author":"Xie","year":"2022","journal-title":"Int Immunopharmacol"},{"key":"2026021212221198300_hcaf180-B22","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1111\/pai.13611","article-title":"Recurrent assessment of lymphocyte subsets in 32 patients with multisystem inflammatory syndrome in children (MIS-C)","volume":"32","author":"Okarska-Napiera\u0142a","year":"2021","journal-title":"Pediatr Allergy Immunol"},{"key":"2026021212221198300_hcaf180-B23","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/SHK.0000000000000234","article-title":"Persistent lymphopenia after diagnosis of sepsis predicts mortality","volume":"42","author":"Drewry","year":"2014","journal-title":"Shock"},{"key":"2026021212221198300_hcaf180-B24","doi-asserted-by":"crossref","first-page":"15075","DOI":"10.1038\/s41598-024-64469-8","article-title":"The prognostic value of the combined neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-platelet ratio (NPR) in sepsis","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci Rep"},{"key":"2026021212221198300_hcaf180-B25","doi-asserted-by":"crossref","first-page":"e176957","DOI":"10.1371\/journal.pone.0176957","article-title":"A comparison of the predictive validity of the combination of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and other risk scoring systems for intravenous immunoglobulin (ivig)-resistance in Kawasaki disease","volume":"12","author":"Takeshita","year":"2017","journal-title":"PLoS One"},{"key":"2026021212221198300_hcaf180-B26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s13312-023-2836-1","article-title":"Neutrophil-lymphocyte ratio for predicting coronary artery lesions in children with Kawasaki disease","volume":"60","author":"Chidambaram","year":"2023","journal-title":"Indian Pediatr"}],"container-title":["QJM: An International Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/qjmed\/advance-article-pdf\/doi\/10.1093\/qjmed\/hcaf180\/63992301\/hcaf180.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/118\/12\/902\/63992301\/hcaf180.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/118\/12\/902\/63992301\/hcaf180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T17:22:23Z","timestamp":1770916943000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/qjmed\/article\/118\/12\/902\/8228589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/qjmed\/hcaf180","relation":{},"ISSN":["1460-2725","1460-2393"],"issn-type":[{"value":"1460-2725","type":"print"},{"value":"1460-2393","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,8,8]]}}}