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The combination of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as a novel predictor of intravenous immunoglobulin resistance in patients with Kawasaki disease: a multicenter study

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Abstract

Introduction

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be a predictor for intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) recently. The objective of the present study was to elucidate the predictive validity of this new marker in a multicenter study.

Materials and methods

We retrospectively reviewed the clinical records of 520 consecutive KD patients (development data set) and 332 subsequent patients (validation data set) at 7 hospitals in Japan.

Results

Both NLR and PLR were significantly higher in the IVIG-resistant group than in the IVIG-responsive group. When we set the cut-off point as NLR ≥ 4.11 and PLR ≥ 119, multiple logistic regression analyses showed that a high NLR and PLR before initial IVIG were independent predictors of IVIG resistance, and their combination was a stronger predictor than either alone. The sensitivity and specificity of the combination of NLR ≥ 4.11 and PLR ≥ 119 were 0.58 and 0.73 in the development data set. Validated using an independent data set, they were 0.54 and 0.72 in the validation data set. On comparing the AUC of this predictor with those of the Gunma and Kurume scores, the AUC was highest for this predictor, followed by the Gunma score and Kurume score (0.70, 0.68, and 0.64, respectively).

Discussion

The predictive validity of the combination of a high NLR and PLR, which is a simple and convenient indicator, was equal to or better than that of the existing scoring systems. The new predictive marker may be a suitable indicator for predicting IVIG resistance in KD patients.

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Abbreviations

KD:

Kawasaki disease

IVIG:

Intravenous immunoglobulin

CAL:

Coronary artery lesions

NLR:

Neutrophil-to-lymphocyte ratio

PLR:

Platelet-to-lymphocyte ratio

ROC:

Receiver operating characteristic

AUC:

Area under the curve

CI:

Confidence interval

OR:

Odds ratio

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Acknowledgements

We thank all investigators and their staff for their contributions to this study at the following institutions: Department of Pediatrics, Koshigaya Municipal Hospital, Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Department of Pediatric Cardiology, Chutoen General Medical Center, Department of Pediatrics, Hamamatsu University School of Medicine, Department of Pediatrics, National Hospital Organization, Nishisaitama-Chuo National Hospital, Department of Pediatrics, University of Toyama, Department of Pediatrics, Seirei Sakura Citizen Hospital, Department of Pediatrics, National Defense Medical College.

Funding

This work was supported in part by grants from Scientific Research (KAKENHI, 16K10082), the Japan Kawasaki Disease Research Center, the Kawasaki Disease Research from Japan Blood Products Organization, and Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics.

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan

    Takashi Kanai, Yoichi Kawamura, Yusuke Yoshida & Shigeaki Nonoyama

  2. Division of Nursing, School of Medicine, National Defense Medical College, Tokorozawa, Japan

    Seiichiro Takeshita

  3. Department of Pediatrics, Koshigaya Municipal Hospital, Koshigaya, Japan

    Keiji Kinoshita

  4. Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan

    Keigo Nakatani

  5. Department of Pediatric Cardiology, Chutoen General Medical Center, Kakegawa, Japan

    Satoru Iwashima

  6. Department of Pediatrics, National Hospital Organization, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan

    Yuji Takizawa

  7. Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan

    Keiichi Hirono

  8. Department of Pediatrics, Seirei Sakura Citizen Hospital, Sakura, Japan

    Kazuetsu Mori

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  1. Takashi Kanai
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Correspondence to Takashi Kanai.

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Kanai, T., Takeshita, S., Kawamura, Y. et al. The combination of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as a novel predictor of intravenous immunoglobulin resistance in patients with Kawasaki disease: a multicenter study. Heart Vessels 35, 1463–1472 (2020). https://doi.org/10.1007/s00380-020-01622-z

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