Neutrophil to Lymphocyte Ratio as a Biomarker for Predicting the Coronary Artery Abnormality in Kawasaki Disease: A Meta-Analysis

Abstract

We conducted a systematic review and meta-analysis on the relationship between the neutrophil to lymphocyte ratio (NLR) and coronary artery abnormalities (CAA) in patients with Kawasaki disease (KD), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. We searched PubMed, Scopus, Web of Science, Embase, TRIP, Google Scholar, and ProQuest up to the 8th of August 2022. This was done to retrieve eligible studies. No date or language limitations were considered in this study. Methodology quality assessment was conducted according to the Newcastle–Ottawa scale (NOS). Standard mean difference (SMD) and its 95% confidence interval (CI) were used to depict the pooled continuous variables. Finally, 17 articles with 6334 KD patients, of whom 1328 developed CAA, were enrolled in this meta-analysis. NLR level was significantly higher in KD patients with CAA compared to those without CAA (SMD =0.81; 95% CI =0.05–1.57, P = 0.03 ). In addition, NLR level was significantly higher in patients with coronary artery aneurysms than those without coronary artery aneurysms (SMD =2.29; 95% CI =0.18–4.41, P = 0.03 ). However, no significant association between NLR and coronary artery dilation was observed in this meta-analysis (SMD =0.56; 95% CI = -0.86–1.99). There was no publication bias for the pooled SMD of NLR for coronary artery abnormality in KD (Egger’s test P = 0.82 ; Begg’s test P = 0.32 ). The NLR may be useful in monitoring CAA development in these patients and may further imply a mechanistic role in potential inflammation that mediates this process.

Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients

“…The same conclusion was reported in another meta-analysis [25]. The NLR may also be a useful biomarker in differentiating patients requiring in-depth diagnostics for coronary artery abnormalities and in patients with Kawasaki disease [26]. In the context of acute pulmonary embolism, the NLR turned out to be a good predictor of short-term (in-hospital and 30-day) mortality and long-term mortality [27].…”

Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature

“…TAK is not solely a unique disease characterized by inflammation of the major arterial branches that causes narrowing of the arteries or aneurysms. It is important to mention acute arteritis, which occurs in children around 5 years of age [ 121 ]. In Kawasaki disease, similarly to TAK, the inflammatory process is complex, and IL-6, IL-8, TNF-α, IFN-γ, and CRP are involved in the course of the disease.…”

“…In Kawasaki disease, similarly to TAK, the inflammatory process is complex, and IL-6, IL-8, TNF-α, IFN-γ, and CRP are involved in the course of the disease. Data suggests that dysregulation of the inflammatory response is involved in the disease progression and enlargement of aneurysms’ [ 121 ]. Particularly, high levels of neutrophils facilitate the infiltration of arterial vessels, resulting in necrosis and aneurysms.…”

“…Therefore, the prognostic markers of adverse prognosis are important to identify. A systematic review and meta-analysis of seventeen studies indicated an important role of the elevated levels of the neutrophil-to-lymphocyte ratio on the formation of coronary abnormalities and aneurysms in patients with Kawasaki disease [ 121 ]. In line with this, a recently published study showed the specific patterns of the endothelial cell response that leads to the destruction of vascular smooth muscle cells and arterial structures, progressing, in consequence, to the specific cardiovascular outcomes of Kawasaki disease [ 122 ].…”

Conduction System Disease in Victims of COVID-19

“…The prevalence of AVB was 3.5%. Among them, 2 were associated with MI, 2 had metabolic abnormalities, suggesting that refractory shock was primarily responsible for conduction block, and 1 patient had AV block in the setting of non-ST-segmentelevation myocardial infarction and newly depressed left ventricular ejection fraction (9)(10)(11). However, no association between the presence of AVB and mortality was reported in these articles.…”