Neutrophil-to-lymphocyte ratio as a biomarker for predicting the intravenous immunoglobulin-resistant Kawasaki disease

Background: The prediction of intravenous immunoglobulin (IVIG) resistance and cardiovascular complications are critically clinical issues in Kawasaki disease (KD). This prospective study firstly aimed to determine the predictive ability of the systemic immune inflammation index (SII) for IVIG resistance and cardiovascular complications and compare the prognostic accuracy of SII with that of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR).Methods: Patients with KD were divided into different groups according to the presence of IVIG resistance or cardiovascular complications (coronary artery lesions, valve regurgitation, myocarditis, pericardial effusion, and Kawasaki disease shock syndrome [KDSS]). The clinical and laboratory parameters were compared. Further analysis stratified by platelet level was performed. Multivariate logistic regression analysis was used to identify predictors for IVIG resistance and cardiovascular complications. The receiver operating characteristic (ROC) curve was applied to assess and compare the ability of SII, NLR, and PLR for predicting IVIG resistance and cardiovascular complications.Results: SII was significantly higher in KD patients with IVIG-resistance, myocarditis, valve regurgitation, and KDSS. It was identified as an independent risk factor for IVIG resistance, myocarditis, and valve regurgitation. For KD patients with thrombocytopenia, there were no significant differences in SII between KD patients with IVIG resistance/cardiovascular complications and those without. The best cutoff values of SII for IVIG resistance, myocarditis, valve regurgitation, and KDSS prediction in the whole cohort were 1331.4 × 109, 1368.6 × 109, 1002.4 × 109, and 1485.4 × 109, with a corresponding sensitivity of 0.525, 0.614, 0.754, and 0.670, a specificity of 0.711, 0.723, 0.584, and 0.730, respectively. The predictive value of SII for both IVIG resistance and cardiovascular complications were not superior to that of NLR.Conclusion: Although the parameter of SII may predict IVIG resistance, myocarditis, valve regurgitation, and KDSS in KD as a single parameter, its predictive ability was not good enough and not superior to NLR. SII might not be applicable in patients with KD having thrombocytopenia.

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Neutrophil-to-lymphocyte ratio and scoring system for predicting coronary artery lesions of Kawasaki disease

BMC Pediatrics ◽

10.1186/s12887-020-02285-5 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ling-Sai Chang ◽

Yi-Ju Lin ◽

Jia-Huei Yan ◽

Mindy Ming-Huey Guo ◽

Mao-Hung Lo ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Scoring System ◽

Neutrophil To Lymphocyte Ratio ◽

Coronary Artery Lesions ◽

Lymphocyte Ratio

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Comparison of Complete Blood Count Parameters in Children with Kawasaki Disease and Viral Febrile Infections

Trends in Pediatrics ◽

10.5222/tp.2020.09797 ◽

2020 ◽

Author(s):

Serkan Fazlı Çelik ◽

Soner Sertan Kaya ◽

Elif Çelik ◽

Şükrü Güngör

Keyword(s):

Kawasaki Disease ◽

Coronary Arteries ◽

Blood Count ◽

Complete Blood Count ◽

Clinical Symptoms ◽

Neutrophil To Lymphocyte Ratio ◽

Immune Reactivity ◽

Lymphocyte Ratio ◽

Childhood Vasculitis ◽

Symptoms And Signs

INTRODUCTION: Kawasaki disease (KD) is a childhood vasculitis, and the inflammation of coronary arteries is the most severe complication of KD. Despite the fever, diagnosis may be delayed when clinical symptoms do not fulfill the criteria. In this study, we aimed to determine whether the complete blood count (CBC) parameters can differentiate KD from other diseases that caused fever in children. METHODS: The present study included 51 patients, 21 of whom were diagnosed as KD and 30 febrile non-KD patients who had viral or infections. We analyzed groups' initial CBC parameters in the first visit. RESULTS: Fourteen of the 21 patients (66%) were atypical KD. There were no statistically significant differences in patients' characteristics, clinical symptoms, and signs between the groups. Six of the patients had abnormal coronary arteries like dilatation. A higher neutrophil-to-lymphocyte ratio (NLR) (2.5 (1.8–5.9) vs. 1.41 (0.89–3.6); p=0.028, retrospectively) and higher CRP levels (58.1 (25.6–129.3) vs. 22.8 (4.3–41.6); p= 0.021, retrospectively) were found in KD group when compared with non- KD group. When combining NLR> 1.41 and CRP> 31 mg/L, there was a higher odds ratio of 24.84 (95% confident interval (2.41–198.53) of KD predicting the possibility. DISCUSSION AND CONCLUSION: Neutrophil-to-lymphocyte ratio and CRP can show inflammation and immune reactivity, and they can be used to distinguish KD patients from virally infected children.

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