Department of Pediatric Cardiology, The Cardiac Development and Early Intervention Unit, The Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; The Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China Medical School of Sichuan University, Chengdu, Sichuan 610041, China.
Department of Pediatric Cardiology, The Cardiac Development and Early Intervention Unit, The Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; The Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China Medical School of Sichuan University, Chengdu, Sichuan 610041, China.
Int Immunopharmacol. 2022 Sep;110:108986. doi: 10.1016/j.intimp.2022.108986. Epub 2022 Jun 25.
Intravenous immunoglobulin (IVIG) resistance and cardiovascular complications prediction are pivotal topic of interests in Kawasaki disease (KD). The prognostic nutritional index (PNI) has been proposed to be valuable in predicting the severity of inflammatory status and prognosis in clinical circumstances, with limited data in KD. Therefore, we prospectively investigated the role of sampling-time specific PNI cut-off values in predicting initial IVIG resistance as well as cardiovascular complications in patients with KD for the first time.
A total of 755 patients with KD were prospectively recruited between January 2015 and December 2019. Patients with KD were subgrouped based on the presence of IVIG resistance or cardiovascular complications. The clinical and laboratory parameters were compared. Multivariate logistic regression analysis was performed to identify the independent risk factors for IVIG resistance and cardiovascular complications. The receiver operating characteristic (ROC) curve was further applied to assess the predictive values of PNI in IVIG resistance and cardiovascular complications.
The lower level of PNI was identified as independent risk factors for initial IVIG resistance and cardiovascular complications. The discriminating cut-off values of the PNI for IVIG resistance, all cardiovascular complications, CALs, KDSS and myocarditis were 47.8, 52.2, 38.6, 48.2 and 52.0, with the corresponding sensitivities of 0.573, 0.679, 0.174, 0.750, 0.851, and specificities of 0.753, 0.549, 0.957, 0.679 and 0.576, respectively. After sampling time stratification, the sensitivities and specificities of the PNI obtained at the sixth day from fever onset for prediction of both IVIG resistance (0.778, 0.787) and all cardiovascular complications (0.667, 0.753) remarkably improved.
PNI may serve as a promising predictor for KDSS in patients with KD. PNI obtained at sixth day from fever onset possess good predictive power for both IVIG resistance and all cardiovascular complications in KD.
静脉注射免疫球蛋白（IVIG）抵抗和心血管并发症预测是川崎病（KD）研究的热点。预后营养指数（PNI）已被提出可用于预测炎症状态和临床情况下的预后，在 KD 中的数据有限。因此，我们首次前瞻性研究了采样时间特异性 PNI 截断值在预测 KD 患者初始 IVIG 抵抗和心血管并发症中的作用。
2015 年 1 月至 2019 年 12 月期间，我们前瞻性招募了 755 名 KD 患者。根据是否存在 IVIG 抵抗或心血管并发症，将 KD 患者分为亚组。比较临床和实验室参数。采用多变量逻辑回归分析确定 IVIG 抵抗和心血管并发症的独立危险因素。进一步应用受试者工作特征（ROC）曲线评估 PNI 在 IVIG 抵抗和心血管并发症中的预测价值。
较低的 PNI 水平被确定为初始 IVIG 抵抗和心血管并发症的独立危险因素。PNI 预测 IVIG 抵抗、所有心血管并发症、冠状动脉瘤、KDSS 和心肌炎的截断值分别为 47.8、52.2、38.6、48.2 和 52.0，相应的灵敏度分别为 0.573、0.679、0.174、0.750、0.851，特异性分别为 0.753、0.549、0.957、0.679 和 0.576。在采样时间分层后，发热第 6 天获得的 PNI 预测 IVIG 抵抗（0.778、0.787）和所有心血管并发症（0.667、0.753）的灵敏度和特异性显著提高。
PNI 可能是 KD 患者 KDSS 的有前途的预测指标。发热第 6 天获得的 PNI 对 KD 患者的 IVIG 抵抗和所有心血管并发症均具有良好的预测能力。
