Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

Abstract

Objectives We aimed to evaluate the clinical and laboratory characteristics of patients with Kawasaki disease (KD) before and after therapy. Methods Patients with KD were divided into different groups according to their responsiveness to initial intravenous immunoglobulin (IVIG) treatment and coronary status. The clinical and laboratory parameters before and after therapy were compared. Multivariate analysis was performed to identify the independent risk factors, and the receiver operating characteristic (ROC) curve was applied to assess and compare the prediction ability of risk factors and their fluctuations. Results Of the 153 patients included in the study, 41 (26.8%) had IVIG resistance and 37 (24.2%) had developed CAA. After stratifying by therapy response, the two groups differed in the levels of total bilirubin (TSB), albumin, and sodium, neutrophil-to-lymphocyte count ratio (NLR), platelet-to-lymphocyte count ratio (PLR), TSB-to-albumin (B/A) ratio, and prognostic nutritional index (PNI) before IVIG, and in the white blood cell count (WBC), neutrophil count, levels of hemoglobin, C-reactive protein (CRP), alanine aminotransferase (ALT), and albumin, NLR, PNI, capillary leakage index (CLI), and systemic immune-inflammation index (SII) after IVIG. Multivariate analysis revealed that the B/A ratio before IVIG and CLI and SII after IVIG were significantly and positively associated with IVIG resistance and that there was a larger decline in the B/A ratio and smaller decline in CLI and SII pre- and post-treatment in the IVIG-resistant group than in the IVIG-responsive group. However, no statistical differences in the fluctuations of the B/A ratio, CLI, and SII as well as all parameters before and after therapy were observed in patients with and without CAA. ROC curve analyses found a greater AUC value of post-treatment parameters (0.751 and 0.706 for CLI and SII, respectively) compared with pre-treatment parameters (0.654 for B/A ratio) in predicting IVIG resistance; however, the predictive ability of the fluctuations in risk factors before and after therapy was not superior to that of baseline values. Conclusions The B/A ratio before IVIG and CLI and SII after IVIG were risk factors for IVIG resistance in patients with KD, independent of CAA development. Key Points• A high total bilirubin-to-albumin ratio before IVIG and high capillary leakage and systemic immune-inflammation indices after IVIG may indicate an increased risk of intravenous immunoglobulin resistance in patients with Kawasaki disease.• Post-treatment parameters were superior to pre-treatment parameters in terms of prediction; therefore, rapid and repeated assessment of risk factors before and after treatment must be considered in children in whom the vital signs and symptoms do not improve after treatment.

Prognostic nutritional index value in the prognosis of Kawasaki disease with coronary artery lesions

“…Although missing data and the small sample size (persistent CAA group) prevented us from investigating the role of sampling-time-specific PNI cutoff values in predicting persistent CAA, these findings provide important evidence regarding the discrepancies in the predictive values for IVIG resistance and CAA development by the same parameter. Interestingly, the lowest PNI value in both the persistent CAA and the normal groups occurred on day 6, which is consistent with the results of our previous studies and other reports ( 23 , 58 – 60 ). Thus, pediatricians and cardiovascular specialists should focus not only on patients with CAA with a higher maximum Z -score at 1 month after onset, but also on patients with low PNI levels, as these can predict persistent CAA within a few days after illness onset.…”

Values of prognostic nutritional index for predicting Kawasaki disease: a systematic review and meta-analysis

“…In addition, neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been confirmed for their discriminative abilities to predict IVIGresistant KD patients in previous reports (35,36). This research indicated that PNI is at its lowest on the 6th day of disease onset, while SII is at its highest, demonstrating that both PNI and SII exhibit good predictive capabilities for KD with IVIG resistance on the 6th day of the disease course (33). The combined diagnosis of these two markers may enhance the diagnostic accuracy for KD with IVIG resistance, which is consistent with another study (16).…”

“…Currently, an increasing number of studies are emerging regarding the diagnostic and prognostic value of PNI in various diseases. A previous meta-analysis investigated the value of PNI in the prognosis of cardiovascular diseases and showed that PNI can independently (17,33,34). In addition, neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been confirmed for their discriminative abilities to predict IVIGresistant KD patients in previous reports (35,36).…”

Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study

“…A correlation between B/A ratio levels and bilirubin encephalopathy has been shown, with higher B/A ratios increasing the bilirubin encephalopathy risk by 23% [ 36 ]. In addition, a high B/A ratio can predict resistance to intravenous immunoglobulin in patients at high risk for Kawasaki disease [ 37 ].…”