Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530000, China.
Clin Rheumatol. 2023 Jan;42(1):167-177. doi: 10.1007/s10067-022-06366-x. Epub 2022 Sep 21.
We aimed to evaluate the clinical and laboratory characteristics of patients with Kawasaki disease (KD) before and after therapy.
Patients with KD were divided into different groups according to their responsiveness to initial intravenous immunoglobulin (IVIG) treatment and coronary status. The clinical and laboratory parameters before and after therapy were compared. Multivariate analysis was performed to identify the independent risk factors, and the receiver operating characteristic (ROC) curve was applied to assess and compare the prediction ability of risk factors and their fluctuations.
Of the 153 patients included in the study, 41 (26.8%) had IVIG resistance and 37 (24.2%) had developed CAA. After stratifying by therapy response, the two groups differed in the levels of total bilirubin (TSB), albumin, and sodium, neutrophil-to-lymphocyte count ratio (NLR), platelet-to-lymphocyte count ratio (PLR), TSB-to-albumin (B/A) ratio, and prognostic nutritional index (PNI) before IVIG, and in the white blood cell count (WBC), neutrophil count, levels of hemoglobin, C-reactive protein (CRP), alanine aminotransferase (ALT), and albumin, NLR, PNI, capillary leakage index (CLI), and systemic immune-inflammation index (SII) after IVIG. Multivariate analysis revealed that the B/A ratio before IVIG and CLI and SII after IVIG were significantly and positively associated with IVIG resistance and that there was a larger decline in the B/A ratio and smaller decline in CLI and SII pre- and post-treatment in the IVIG-resistant group than in the IVIG-responsive group. However, no statistical differences in the fluctuations of the B/A ratio, CLI, and SII as well as all parameters before and after therapy were observed in patients with and without CAA. ROC curve analyses found a greater AUC value of post-treatment parameters (0.751 and 0.706 for CLI and SII, respectively) compared with pre-treatment parameters (0.654 for B/A ratio) in predicting IVIG resistance; however, the predictive ability of the fluctuations in risk factors before and after therapy was not superior to that of baseline values.
The B/A ratio before IVIG and CLI and SII after IVIG were risk factors for IVIG resistance in patients with KD, independent of CAA development. Key Points • A high total bilirubin-to-albumin ratio before IVIG and high capillary leakage and systemic immune-inflammation indices after IVIG may indicate an increased risk of intravenous immunoglobulin resistance in patients with Kawasaki disease. • Post-treatment parameters were superior to pre-treatment parameters in terms of prediction; therefore, rapid and repeated assessment of risk factors before and after treatment must be considered in children in whom the vital signs and symptoms do not improve after treatment.
评估川崎病（KD）患者治疗前后的临床和实验室特征。
根据对初始静脉注射免疫球蛋白（IVIG）治疗的反应和冠状动脉情况，将 KD 患者分为不同组。比较治疗前后的临床和实验室参数。进行多变量分析以确定独立的危险因素，并应用受试者工作特征（ROC）曲线评估和比较危险因素及其波动的预测能力。
在纳入的 153 例患者中，41 例（26.8%）存在 IVIG 抵抗，37 例（24.2%）发生冠状动脉瘤（CAA）。根据治疗反应分层后，两组在 IVIG 前的总胆红素（TSB）、白蛋白和钠、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、TSB 与白蛋白（B/A）比值和预后营养指数（PNI）以及白细胞计数（WBC）、中性粒细胞计数、血红蛋白水平、C 反应蛋白（CRP）、丙氨酸氨基转移酶（ALT）和白蛋白、NLR、PNI、毛细血管渗漏指数（CLI）和全身免疫炎症指数（SII）方面存在差异。多变量分析显示，IVIG 前的 B/A 比值和 IVIG 后的 CLI 和 SII 与 IVIG 抵抗显著正相关，且 IVIG 抵抗组的 B/A 比值治疗前后下降幅度更大，CLI 和 SII 下降幅度较小。然而，在有无 CAA 的患者中，B/A 比值、CLI 和 SII 的波动以及治疗前后的所有参数均无统计学差异。ROC 曲线分析发现，治疗后参数的 AUC 值大于治疗前参数（CLI 和 SII 分别为 0.751 和 0.706，B/A 比值为 0.654），用于预测 IVIG 抵抗；然而，治疗前后危险因素波动的预测能力并不优于基线值。
KD 患者 IVIG 抵抗的独立危险因素包括 IVIG 前的 B/A 比值和 IVIG 后的 CLI 和 SII。
IVIG 前的总胆红素与白蛋白比值高，IVIG 后的毛细血管渗漏和全身免疫炎症指数高，可能提示川崎病患者发生 IVIG 抵抗的风险增加。
治疗后参数在预测方面优于治疗前参数；因此，在治疗后生命体征和症状未改善的患儿中，必须考虑在治疗前后快速、反复评估危险因素。
