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

Abstract

ObjectivesThe prognostic nutritional index (PNI) is a purported predictor of intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD). However, limited data exist on CAA regression. This study aimed to confirm whether the PNI is a predictor for CAA persistency in patients with KD.MethodsThis retrospective study grouped 341 patients with KD based on the coronary artery status and time of aneurysm persistence. The clinical and laboratory parameters were compared, and multivariate logistic regression analysis was performed to identify the independent risk factors for persistent CAA. The receiver operating characteristic (ROC) curve was further used to assess the predictive values of the PNI in persistent CAA.ResultsAmong the study patients, 80 (23.5%) presented with CAA, including CAA persisting for 2 years in 17 patients (5.0%). Patients with CAA were more frequently treated with corticosteroids (p < 0.016). No statistically significant differences were found in the nutritional status and PNI among patients with or without coronary artery lesions, regardless of injury severity. Patients in the persistent CAA group presented with higher rates of overnutrition and showed lower PNI values and a higher incidence of thrombosis than those in the normal group (p < 0.05). The PNI and the maximum Z-score at 1 month of onset were significantly associated with CAA persisting for 2 years and may be used as predictors of persistent CAA. The area under the ROC curve was 0.708 (95% confidence interval, 0.569–0.847), and a 40.2 PNI cutoff yielded a sensitivity and specificity of 41 and 92%, respectively, for predicting CAA persisting for 2 years. Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in patients with PNI values of ≤40 than in those with PNI values of >40 (hazard ratio, 2.958; 95% confidence interval, 1.601–5.464; p = 0.007). After sampling-time stratification, the PNI differed significantly between patients with and without persistent CAA when sampled on the second (p = 0.040), third (p = 0.028), and fourth days (p = 0.041) following disease onset.ConclusionA lower PNI value is an independent risk factor for CAA persisting for 2 years in patients with KD, besides the maximum Z-score at 1 month after onset. Furthermore, the PNI obtained within 4 days from fever onset may possess greater predictive power for patients with persistent CAA.

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

“…The study revealed an association between low pretreatment PNI levels and a high incidence of CAL as well as IVIG resistance in KD patients, which was consistent with a previous study (18). The key variation among these studies lies in the PNI cutoff values.…”

“…Over the past decades, malnutrition has garnered widespread attention as a prognostic indicator for various diseases, including acute myocardial infarction, heart failure, and various cancers (11, 26-30). Hence, some researchers have demonstrated that PNI may serve as a superior indicator for assessing the inflammatory and immune system status in KD patients (16,18,21). The PNI may provide early diagnosis and predictions for IVIG resistance in KD patients, as well as KD-CAL patients, thereby assisting in the timely implementation of appropriate treatment strategies for KD patients (16).…”

“…The summarized characteristics of the included studies are presented in Table 1. From 2020 to 2023, a total of 8 articles containing 10 studies were eligible (15)(16)(17)(18)(21)(22)(23)(24). The majority of these studies were conducted in mainland China (8/10), one study from Taiwan, China, and one from Turkey.…”

“…In recent years, some studies have suggested that PNI could predict IVIG resistance and CAL in patients with KD (15)(16)(17)(18). However, there are no consistent conclusions about the diagnostic accuracy of PNI in KD patients with IVIG resistance and CAL.…”

Evaluation of the Association Between Coronary Artery Aneurysms and Concomitant Infection in Patients With Kawasaki Disease

“…20,21 Currently, the initial ratio of neutrophils to lymphocytes, γ-glutamyl transpeptidase, prognostic nutritional index (PNI), and CAA size are reported as risk factors for persistent CAAs. 22,23 However, the effect of concomitant infections was not considered in the above studies. In this study, we aimed to analyze the relationship between CAA formation and infections in patients with KD and further evaluate the relationship between concurrent infections and CAAs without recovery for a 2-year follow-up period.…”