The usefulness of neutrophil-to-lymphocyte ratio in predicting coronary artery dilation with Kawasaki disease / 中华实用儿科临床杂志

ABSTRACT

Objective To assess the neutrophil-to-lymphocyte ratio (NLR) to predict coronary artery dilation in patients with Kawasaki disease (KD).Methods The blood routine were collected from all patients with KD before intravenous immunoglobulin(IVIG) treatment and after 2 days of IVIG treatment.NLR was calculated through dividing the neutrophil count by the lymphocyte.Multivariate Logistic analysis and receiver-operating characteristic (ROC) curve were used to determine the value of NLR predicting coronary artery dilation and the risk factors of coronary artery dilation in KD.Results Of the 404 cases with KD,50 cases were coronary artery dilation.Compared with the patients without coronary artery dilatation,patients with coronary artery dilatation were more inclined to occur in males (76.0％ vs.51.7％,x2 =10.45,P ＜0.01) at younger ages[(26.5 ±7.1) months vs.(31.3 ±8.4) months,t =3.85,P ＜ 0.01],while the days of fever pre-IVIG treatment [(6.9 ± 1.6) d vs.(5.5 ± 1.2) d,t =7.38,P ＜ 0.01] and after IVIG treatment [(4.7 ± 1.3) d vs.(2.1 ± 0.9) d,t =17.97,P ＜ 0.01] as well as total fever days [(10.2 ± 3.7) d vs.(7.5 ± 2.5) d,t =6.68,P ＜ 0.01] were all longer.Meanwhile,before IVIG treatment,patients with coronary artery dilatation had higher leukocytes [(18.6 ± 5.2) × 109/L vs.(15.4 ± 4.4) × 109/L,t =4.70,P ＜0.01],NLR value (4.5 ±0.8 vs.3.1 ± 0.4,t =19.82,P ＜0.01),neutrophil [(13.7 ±6.3) × 109/L vs.(10.2 ± 4.3) × 109/L,t =5.05,P＜0.01] and C-reactive protein(CRP) [(108.4 ±26.9) mg/Lvs.(99.5 ±32.3) mg/L,t =1.86,P ＜ 0.05],and the differences were statistically significant.However,between coronary artery dilatation group and non-coronary artery dilatation group,the lymphocyte number,platelet and erythrocyte sedimentation rate were not significantly different before IVIG treatment (all P ＞ 0.05).And the WBC [(10.4 ± 5.2) × 109/L vs.(8.3 ± 4.6) × 109/L,t=3.04,P＜0.01],NLR value (2.1 ±0.7 vs.1.2 ±0.5,t =13.87,P ＜0.01),nentrophil [(8.2 ± 1.7) × 109/L vs.(5.3 ± 1.2) × 109/L,t =16.37,P ＜0.01],platelet (PLT) [(492.4 ± 68.3) × 109/L vs.(445.6 ± 82.4) ×109/L,t=3.84,P＜0.01],CRP [(46.2±28.8) mg/L vs.(19.5±10.8) mg/L,t=12.47,P＜0.01],ESR[(45.9 ±28.6) mm/1 h vs.(28.2 ± 15.7) mm/1 h,t =6.63,P ＜0.01] of patients with coronary artery dilatation after IVIG treatment were also higher than the patients without coronary artery dilatation,and all of the differences were statistically significant.The ROC curve result revealed that the best NLR cut-off value during the acute febrile phase for predicting coronary artery dilation was 4.51,and the area under the curve was 0.82 (95％ CI 0.75-0.89) with sensitivity and specificity of 0.78 and 0.80,respectively.At the same time the best NLR cut-off values in 2 days after IVIG for predicting coronary artery dilation was 1.46,and the area under the curve was 0.85 (95％ CI 0.79-0.92) with sensitivity and specificity of 0.84 and 0.79,respectively.Multivariate Logistic analysis revealed that the days of fever before and after IVIG treatment,total fever days,NLR before and after IVIG treatment,as well as WBC and CRP after treatment with IVIG were all independent predictive factors of coronary artery dilation development.Conclusion The NLR could be used to predict coronary artery dilation development in patients with KD.