Value of Neutrophil-Lymphocyte Ratio in Predicting Outcomes in Kawasaki Disease

Ha, Kee Soo; Lee, Jeehoo; Jang, Gi Young; Lee, Jung Hwa; Lee, Kwang Chul; Son, Chang-Sik; Lee, Joo Won

doi:10.1016/j.amjcard.2015.04.021

Cited by 63 publications

(81 citation statements)

References 12 publications

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“…Furthermore, only one patient with a coronary artery aneurysm had the highest NLR value. These findings are consistent with the results of recent studies [5,6]. A recent study using multivariate analysis revealed that NLR after IVIG therapy independently predicted coronary artery aneurysm development and IVIG therapy resistance [5].…”

Section: Discussionsupporting

confidence: 83%

“…These findings are consistent with the results of recent studies [5,6]. A recent study using multivariate analysis revealed that NLR after IVIG therapy independently predicted coronary artery aneurysm development and IVIG therapy resistance [5]. Another study showed that the NLR values in Kawasaki patients with CAL were significantly higher than in those without [6].…”

Section: Discussionsupporting

confidence: 82%

“…Recent studies showed that the neutrophil to lymphocyte ratio (NLR) may be useful for risk stratification in patients with Kawasaki disease [5][6][7]. The objective of this study is to clarify the usefulness of NLR for risk stratification after initial IVIG therapy with DUA in Kawasaki disease.…”

Section: Introductionmentioning

confidence: 99%

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

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2017

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“…Patients with complete differential leukocyte counts at diagnosis and 2 days after IVIG treatment, IVIG response and CAA data were included. Detailed characteristics, clinical data and results of laboratory studies of subjects were previously described [25]. …”

Section: Methodsmentioning

confidence: 99%

Unique Molecular Patterns Uncovered in Kawasaki Disease Patients with Elevated Serum Gamma Glutamyl Transferase Levels: Implications for Intravenous Immunoglobulin Responsiveness

Wang

et al. 2016

PLoS ONE

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BackgroundResistance to intravenous immunoglobulin (IVIG) occurs in 10–20% of patients with Kawasaki disease (KD). The risk of resistance is about two-fold higher in patients with elevated gamma glutamyl transferase (GGT) levels. We sought to understand the biological mechanisms underlying IVIG resistance in patients with elevated GGT levels.MethodWe explored the association between elevated GGT levels and IVIG-resistance with a cohort of 686 KD patients (Cohort I). Gene expression data from 130 children with acute KD (Cohort II) were analyzed using the R square statistic and false discovery analysis to identify genes that were differentially represented in patients with elevated GGT levels with regard to IVIG responsiveness. Two additional KD cohorts (Cohort III and IV) were used to test the hypothesis that sialylation and GGT may be involved in IVIG resistance through neutrophil apoptosis.ResultsThirty-six genes were identified that significantly explained the variations of both GGT levels and IVIG responsiveness in KD patients. After Bonferroni correction, significant associations with IVIG resistance persisted for 12 out of 36 genes among patients with elevated GGT levels and none among patients with normal GGT levels. With the discovery of ST6GALNAC3, a sialyltransferase, as the most differentially expressed gene, we hypothesized that sialylation and GGT are involved in IVIG resistance through neutrophil apoptosis. We then confirmed that in Cohort III and IV there was significantly less reduction in neutrophil count in IVIG non-responders.ConclusionsGene expression analyses combining molecular and clinical datasets support the hypotheses that: (1) neutrophil apoptosis induced by IVIG may be a mechanism of action of IVIG in KD; (2) changes in sialylation and GGT level in KD patients may contribute synergistically to IVIG resistance through blocking IVIG-induced neutrophil apoptosis. These findings have implications for understanding the mechanism of action in IVIG resistance, and possibly for development of novel therapeutics.

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“…In addition, a study reported that circulating plateletneutrophil aggregates might play a role in amplifying acute inflammation and CALs 14) ; another study found that NLR was higher in KD patients with CALs than those without CALs 15) . In this series, we also found that the patients with CALs had significantly longer fever duration and higher platelet and NLR values, which may indicate more severe systemic inflammation.…”

Section: Discussionmentioning

confidence: 99%