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The use of neutrophil–lymphocyte ratio for the prediction of refractory disease and coronary artery lesions in patients with Kawasaki disease

Published online by Cambridge University Press:  04 April 2023

Juan S. Farias Open the ORCID record for Juan S. Farias [Opens in a new window] ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Fabio Savorgnan ,
Sebastian Acosta Open the ORCID record for Sebastian Acosta [Opens in a new window] ,
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]  and
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]
Juan S. Farias*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Enrique G. Villarreal
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Fabio Savorgnan
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Sebastian Acosta
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Saul Flores
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Rohit S. Loomba
Affiliation:
Division of Pediatric Cardiac Critical Care, Advocate Children’s Hospital, Oak Lawn, IL, USA Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
*
Author for correspondence: Juan S. Farias, MD, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto 3000, Colonia Los Doctores, 64710, Monterrey, Nuevo Leon, Mexico. Tel: +52 81 1588 8197. E-mail: jsfariast@gmail.com
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Abstract

Background:

Kawasaki disease is a vasculitis that can lead to cardiac complications, including coronary artery disease and cardiogenic shock. Various scoring systems have been developed to determine those that will be refractory to routine intravenous immunoglobulin therapy or develop coronary artery disease. The objective of this study was to determine if the neutrophil–lymphocyte ratio could predict refractory disease and coronary artery lesions in patients with Kawasaki disease.

Methods:

A systematic review of the literature was performed to identify manuscripts describing comparisons of neutrophil–lymphocyte ratio between those who had refractory disease and those who did not, and between those who developed coronary artery lesions and those who did not. Mean difference was compared between groups. Areas under the curve were utilised to determine the pooled area under the curve.

Results:

12 studies with 5593 patients were included in the final analyses of neutrophil–lymphocyte ratio for the prediction of refractory disease. Neutrophil–lymphocyte ratio before therapy was higher in refractory disease with a mean difference of 2.55 (p < 0.01) and pooled area under the curve of 0.724. Neutrophil–lymphocyte ratio after therapy was higher in refractory disease with a mean difference of 1.42 (p < 0.01) and pooled area under the curve for of 0.803. Five studies with 1690 patients were included in the final analyses of neutrophil–lymphocyte ratio for the prediction of coronary artery lesions. Neutrophil–lymphocyte ratio before therapy was higher in coronary artery lesions with a mean difference of 0.65 (p < 0.01).

Conclusion:

The use of neutrophil–lymphocyte ratio may help physicians in the identification of patients at risk of refractory disease and coronary artery lesions in patients with Kawasaki disease.

Keywords

Kawasaki diseasecoronary aneurysmsintravenous immunoglobulinsneutrophil–lymphocyte ratio
Type
Review
Information
Cardiology in the Young , Volume 33 , Issue 8 , August 2023 , pp. 1409 - 1417
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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