Abstract：Objective To study the values of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting the sensitivity to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD). Methods A retrospective cohort study was conducted in 404 children with newly diagnosed KD. The data on routine blood tests, NLR, and PLR were collected before and after IVIG treatment. The receiver operating characteristic (ROC) curve was used to determine the cut-off values of NLR and PLR in predicting the insensitivity to IVIG. A logistic regression analysis was used to identify independent predictive factors for insensitivity to IVIG. Results Of all patients, 31 were insensitive to IVIG. Compared with the IVIG sensitivity group, the IVIG insensitivity group had a significantly higher incidence rate of coronary artery ectasia (P < 0.01), a shorter course of disease when IVIG therapy was initiated (P < 0.05), and significantly higher NLR, PLR, and C-reactive protein (CRP) level before and after treatment (P < 0.05). The optimal cut-off values for NLR and PLR to predict IVIG insensitivity were 4.36 and 162 before IVIG treatment and 1.45 and 196 after treatment. The multivariate regression analysis showed that the course of disease before IVIG treatment, CRP before IVIG treatment, and NLR and PLR before and after IVIG treatment were independent predictive factors for IVIG insensitivity. Conclusions NLR and PLR can be used to predict IVIG insensitivity in children with KD.
YUAN Ying-Di,SUN Jun,LI Peng-Fei et al. Values of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting sensitivity to intravenous immunoglobulin in Kawasaki disease[J]. CJCP, 2017, 19(4): 410-413.
McCrindle BW, Li JS, Minich LL, et al. Coronary artery involvement in children with Kawasaki disease:risk factors from analysis of serial normalized measurements[J]. Circulation, 2007, 116(2):174-179.
[2]
Ha KS, Lee J, Jang GY, et al. Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease[J]. Am J Cardiol, 2015, 116(2):301-306.
[3]
Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease:a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, council on cardiovascular disease in the Young, American Heart Association[J]. Circulation, 2004, 110(17):2747-2771.
[4]
Hwang SY, Shin TG, Jo IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients[J]. Am J Emerg Med, 2017, 35(2):234-239.
[5]
Azab B, Zaher M, Weiserbs KF, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short-and long-term mortality after non-ST-elevation myocardial infarction[J]. Am J Cardiol, 2010, 106(4):470-476.
[6]
Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Am J Cardiol, 2013, 111(5):636-642.
[7]
Acet H, Ertas F, Akıl MA, et al. Relationship between hematologic indices and global registry of acute coronary events risk score in patients with ST-segment elevation myocardial infarction[J]. Clin Appl Thromb Hemost, 2016, 22(1):60-68.
[8]
Lian L, Xia YY, Zhou C, et al. Application of platelet/lymphocyte and neutrophil/lymphocyte ratios in early diagnosis and prognostic prediction in patients with resectable gastric cancer[J]. Cancer Biomark, 2015, 15(6):899-907.
[9]
Çiçek G, Açıkgoz SK, Bozbay M, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Angiology, 2015, 66(5):441-447.
[10]
Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival[J]. Br J Cancer, 2015, 113(2):311-320.
[11]
Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease[J]. Circulation, 2006, 113(22):2606-2612.
[12]
Kim T, Choi W, Woo CW, et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease[J]. Eur J Pediatr, 2007, 166(5):421-425.
[13]
Kawamura Y, Takeshita S, Kanai T, et al. The combined usefulness of the neutrophil-to-lymphocyte and platelet-tolymphocyte ratios in predicting intravenous immunoglobulin resistance with Kawasaki disease[J]. J Pediatr, 2016, 178:281-284.e1.
[14]
Yim D, Curtis N, Cheung M, et al. An update on Kawasaki disease II:clinical features, diagnosis, treatment and outcomes[J]. J Paediatr Child Health, 2013, 49(8):614-623.
Research Committee of Kawasaki Disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease[S]. Tokyo, Japan:Ministry of Health and Welfare, 1984.
[17]
Sato S, Kawashima H, Kashiwagi Y, et al. Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients[J]. Int J Rheum Dis, 2013, 16(2):168-172.
[18]
Daniels LB, Tjajadi MS, Walford HH, et al. Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia[J]. Circulation, 2012, 125(20):2447-2453.
[19]
Adachi S, Sakaguchi H, Kuwahara T, et al. High regression rate of coronary aneurysms developed in patients with immune globulin-resistant Kawasaki disease treated with steroid pulse therapy[J]. Tohoku J Exp Med, 2010, 220(4):285-290.
