High neutrophil : lymphocyte ratio is associated with refractory Kawasaki disease

Cho, Hong-Je; Bak, So Young; Kim, Su Yeong; Yoo, Rita; Baek, Hae-Sung; Yang, Seung; Hwang, Il-Tae; Ban, Ji Eun

doi:10.1111/ped.13240

Cited by 38 publications

(53 citation statements)

References 16 publications

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“…As previously described, IVIG resistance were frequent in KDSS patients, and younger age, mechanical ventilation and gastrointestinal and neurological manifestations were associated with a lack of response to IVIG. NLR has been used to predict coronary aneurysm development and IVIG resistance in KD . NLR is a biomarker of systemic inflammation and a predictor of CAD and IVIG resistance in KD, and we found that NLR was able to predict IVIG resistance but did not correlate with coronary abnormalities.…”

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

Gámez-González

Moribe-Quintero

Cisneros-Castólo³

et al. 2018

Pediatrics International

102

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The presence of coronary aneurysms was significantly and positively correlated with male gender, IVIG resistance, inotrope treatment, cardiac failure, abdominal pain and neurological symptoms. IVIG-resistant patients had higher neutrophil : lymphocyte ratio. Abdominal symptoms, hypoalbuminemia and elevated C-reactive protein were present in almost all of the patients. Multisystem involvement with atypical presentation in KDSS is frequent. An important differential diagnosis is TSS. Mechanical ventilation, gastrointestinal and neurological symptoms were associated with IVIG resistance and the presence of coronary aneurysms. The first line of treatment includes IVIG and pulse corticosteroids; in severe cases, infliximab, anakinra, cyclosporine or plasmapheresis are alternative treatment options.

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Section: Discussionmentioning

confidence: 67%

“…NLR has been used to predict coronary aneurysm development and IVIG resistance in KD. 69,70 NLR is a biomarker of systemic inflammation and a predictor of CAD and IVIG resistance in KD, 69,70 and we found that NLR was able to predict IVIG resistance but did not correlate with coronary abnormalities.…”

Section: Discussionmentioning

confidence: 68%

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

Gámez-González

Moribe-Quintero

Cisneros-Castólo³

et al. 2018

Pediatrics International

102

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“…Kawamura et al 28 reported that NLR value before IVIG ≥3.83 and one day after IVIG ≥1.27 were the best cut-off values for predicting IVIG resistance. Similarly, a study by H-J Cho et al 29 reported that higher NLR values before initial IVIG treatment were associated with increased risk for IVIG resistance and lower NLR changes before and 2 days after IVIG were a predictive tool for coronary artery abnormalities. In current study, we reported best cut-off values of NLR value for IVIG resistance as NLR ≥1.69 before IVIG which had an OR of 4.40 (93.3% sensitivity and 43.4% specificity) and ≥1.25 two days after IVIG which had an OR of 11.29 (85.7% sensitivity and 65% specificity) for IVIG resistance.…”

Section: Discussionmentioning

confidence: 86%

Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease

Türkuçar¹,

Yıldız²,

Açarı³

et al. 2020

Turk J Pediatr

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Kawasaki disease (KD) is an acute, systemic, febrile vasculitis that occurs during infancy and is the most common cause of childhood coronary artery disease. 1 Although, its etiology has not been definitively determined, recent studies have focused on the increased inflammatory cytokines in KD pathology. 2-4 The clinical features include an existence of fever persisting more than five days with mucocutaneous and lymphatic manifestations that are commonly self-limiting. However, the most serious complication is the coronary artery involvement that can be mortal. With the routine use of intravenous immunoglobulin (IVIG) treatment, the incidence of coronary artery lesions (CALs) has declined from 23% to 8%. 5 On the other hand, some patients are at risk for resistance to IVIG treatment and development of CALs. 6 In Turkey, KD was reported as the second most common type of vasculitis in a nationwide study by Ozen et al. 7 , despite the real prevalence being unknown. Previous studies about KD from Turkey reported higher prevalence of coronary arterial involvement than Japanese children based studies. 8-12 Many studies have previously been conducted about the risk factors of KD, and patients with atypical age presentation, elevated acute phase reactants and liver function tests were reported as high risk. 10-12 The Japanese-based risk scoring systems such as that by Kobayashi, Egami, and Sano was reported as inadequate for fully determining the risks for IVIG resistance and CALs in Western populations living in North

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“…Fakat bu ilişkinin detayları tam olarak ortaya konulamamıştır. KH'nin oluşumu ve progresyonu için periferal kan nötrofil sayısı, eritrosit sedimentasyon hızı (ESH), C-Reaktif protein (CRP), laktat dehidrogenaz (LDH), ve inflamatuvar sitokinler [Tümör nekrozis faktör alfa (TNF-a), interlökin (IL)-6 ve IL-10] gibi çeşitli inflamatuvar biyobelirteçler tanımlanmıştır (3). KAT'nin tanısal doğruluğuna yardımcı olmak ve KH'de prognoza yönelik bilgi sağlamak için yeni inflamasyon biyobelirteçleri keşfetmek önemlidir.…”

Section: Introductionunclassified

“…Birçok çalışmada, artmış periferik kan nötrofil, lenfosit, eozinofil ve monosit sayılarının, kardiyovasküler hastalıklar ve komplikasyonlarla yakından ilişkili olduğu gösterilmiştir (4). Son zamanlarda yapılan çalışmalarda, nötrofil: lenfosit oranı (NLO), lenfosit: monosit oranı (LMO), koroner arter hastalığı (KAH) olan erişkin hastalarda, sistemik inflamasyonun biyobelirteçleri olarak bildirilmiştir (3,4). NLO, trombosit: lenfosit oranı (TLO) ve LMO; çeşitli kanserler, kardiyovasküler hastalıklar ve inflamatuar hastalıklarda belirteç olarak araştırılan, inflamasyonu değerlendirmek için kullanılabilen, basit ve ucuz yöntemlerdir (5).…”

Section: Introductionunclassified

Value of Lymphocyte: Monocyte Ratio in Predicting Coronary Artery Abnormalities in Kawasaki Disease

Aydın¹,

Tanır²

2019

BTDMJB

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Objective: Coronary artery abnormalities (CAA) are critical complication of Kawasaki disease (KD). Several inflammatory biomarkers have been identified for occurrence and progression of KD. Discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy of CAA and to provide prognostic information for KD. LMR, are simple and inexpensive methods for assessing inflammation, which have been also investigated as predictors of several cancers, cardiovascular and inflammatory diseases. In this study we aimed to investigate whether LMR is a risk factor of CAA of KD. Methods: We retrospectively reviewed patients with KD from 2005 to 2016. Demographic features, diagnostic clinical features of KD, laboratory findings, complications were recorded prior to IVIG administration. The patients were divided into two groups according to the development of CAA. The LMR was calculated by dividing the number of lymphocytes by the number of monocytes in the peripheral blood count. To identify CAAs risk factors, and to exclude the possible influence of other variables, multivariate analysis was performed by entering significant variables from the univariate analyses. Results: LMR was significantly lower in patients with CAA comparison to the patients without CAA (p<0.05). LMR was found as the only independent variable in multivariate analysis to determine CAA. Conclusion: The findings of this study showed a relationship between lower LMR and a high risk of CAA in children with KD. We suppose that LMR can be used as a predictor of coronary arter involvement in KD as a readily available and inexpensive marker in clinical practice.

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High neutrophil : lymphocyte ratio is associated with refractory Kawasaki disease

Abstract: High NLR was closely associated with resistance to IVIG, but it was not related to the occurrence of coronary abnormalities in KD. Low ΔNLR after IVIG, however, was significantly associated with coronary artery abnormalities.

Cited by 38 publications

References 16 publications

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease

Value of Lymphocyte: Monocyte Ratio in Predicting Coronary Artery Abnormalities in Kawasaki Disease

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