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

https://doi.org/10.1016/j.amjcard.2015.04.021Get rights and content

Total and differential leukocyte counts are useful inflammatory biomarkers. The ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with Kawasaki disease (KD) was assessed in this study. All patients with KD who underwent consecutive complete blood count analyses during the acute febrile phase before intravenous immunoglobulin (IVIG), 2 days after IVIG regardless of defervescence, and 3 to 4 weeks after defervescence were enrolled. NLR was calculated by dividing the neutrophil count by the lymphocyte count. NLR values that best predicted IVIG resistance and the development of coronary artery abnormalities were determined by receiver-operating characteristic curve and multivariate analyses. Of the 587 patients with KD, 222 were IVIG resistant. IVIG-resistant patients had higher NLRs than IVIG-responsive patients. The best NLR cut-off values during the acute febrile phase and 2 days after IVIG for predicting IVIG resistance were 5.49 (p <0.001) and 1.26 (p <0.001), respectively. Sixty-two patients developed coronary artery abnormalities; 47 had coronary dilatation, and 15 had aneurysms. Patients with aneurysms, but not patients with dilatation, had higher NLRs than patients without coronary artery abnormalities. The best NLR cut-off value 2 days after IVIG for predicting aneurysm development was 1.01 (p <0.001). Multivariate analysis revealed that the NLR 2 days after IVIG independently predicted coronary aneurysm development (p = 0.03) and IVIG resistance (p <0.001). In conclusion, the NLR can be used for risk stratification in patients with KD. An NLR 2 days after IVIG that exceeded 1 was predictive of coronary aneurysm development and IVIG resistance.

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Methods

This retrospective cohort study was approved by the institutional review board of Korea University Medical Center. The medical records of all consecutive patients with KD who were treated at the center from January 2008 to December 2013 were reviewed. KD was diagnosed when a patient exhibited ≥5 principal clinical manifestations, including fever >38°C. When the clinical manifestations did not fulfill the diagnostic criteria but other diagnoses could be excluded, incomplete KD was diagnosed if

Results

In the analysis of NLR as a predictor of IVIG resistance, 222 of 587 patients with KD were IVIG resistant (38%). Comparison of the IVIG-responsive and IVIG-resistant groups in terms of demographic and clinical variables (Table 1) revealed that the IVIG-resistant patients were more likely to be male, to be treated with IVIG earlier after the fever started, and to develop coronary dilatation or aneurysm. During the acute febrile phase, the 2 groups did not differ significantly in terms of total

Discussion

This study showed that IVIG-resistant patients had significantly higher NLRs in the acute febrile phase and 2 days after IVIG treatment than IVIG-responsive patients. Similarly, patients with CAAs and coronary aneurysms had higher NLRs than patients without CAAs during the acute febrile phase and particularly 2 days after IVIG. These observations indicate that the NLR can be used for risk stratification in patients with KD.

At the pathologic level, affected coronary arteries in patients with KD

Disclosures

The authors have no conflicts of interest to disclose.

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This study was supported by Grant K1132081 from Korea University, Seoul, Korea.

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