Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China.
Eur J Pediatr. 2023 Oct;182(10):4399-4406. doi: 10.1007/s00431-023-05122-w. Epub 2023 Jul 22.
We aimed to investigate the predictive validity of monocyte to high-density lipoprotein cholesterol ratio (MHR) for coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in complete Kawasaki disease (KD). MHR values of a total of 207 complete KD patients were calculated and analyzed with regard to their clinical characteristics and outcomes. We compared the differences in clinical data and laboratory parameters between CAL+ group and CAL- group as well as between IVIG-resistant group and IVIG-responsive group. Spearman's correlation analysis was applied to evaluate the correlation between C-reactive protein (CRP) and MHR. Multivariate logistic regression was used to identify risk factors of CALs and IVIG resistance. Receiver operating characteristic (ROC) curve analysis was chosen to determine the optimal cut-off value of MHR and its validity in predicting CALs and IVIG resistance. The MHR level was significantly higher in the CAL+ group, with cut-off value of 1.30 g/L, yielding a sensitivity of 0.753 and specificity of 0.805, as well as in IVIG-resistant group, with cut-off value of 1.03 g/L, yielding a sensitivity of 0.97 and specificity of 0.485. Multivariate logistic regression showed that MHR was an independent risk factor for CALs but not for IVIG resistance. According to the Spearman's correlation analysis, CRP was positively correlated with the MHR.
As a practical, cost-effective inflammatory biomarker, MHR has a significantly predictive value in complete KD children complicated with CALs and IVIG-resistance. Paying more attention to the changes of MHR in KD children may contribute to better understanding of KD development and prognosis in clinical practice.
• CALs are the most prevalent serious sequela of KD, and approximately 10%~20% of patients do not respond to IVIG therapy. • MHR could be a convenient biomarker to predict the development and progression of CVDs. It has been reported that the MHR is a new prognostic biomarker in several CVDs.
• MHR has a significantly predictive value in KD children complicated with CALs and IVIG-resistance. • Compared with the molecular and immunological biomarkers that have been reported, MHR has the characteristics of practical, cost-effective, higher sensitivity and specificity, which can be used as a predictive indicator in complete KD patients.
探讨单核细胞与高密度脂蛋白胆固醇比值（MHR）对完全川崎病（KD）患者冠状动脉病变（CALs）及静脉注射免疫球蛋白（IVIG）抵抗的预测价值。
对 207 例完全 KD 患者的 MHR 值进行计算分析，并结合其临床特征及转归进行比较。比较 CAL+组和 CAL-组、IVIG 抵抗组和 IVIG 敏感组间临床资料及实验室参数的差异。采用 Spearman 相关分析评估 C 反应蛋白（CRP）与 MHR 的相关性。采用多因素 logistic 回归分析确定 CALs 和 IVIG 抵抗的危险因素。选择受试者工作特征（ROC）曲线分析确定 MHR 预测 CALs 和 IVIG 抵抗的最佳截断值及其有效性。
CAL+组 MHR 水平显著高于 CAL-组，截断值为 1.30 g/L，敏感性为 0.753，特异性为 0.805；IVIG 抵抗组 MHR 水平亦显著高于 IVIG 敏感组，截断值为 1.03 g/L，敏感性为 0.97，特异性为 0.485。多因素 logistic 回归分析显示，MHR 是 CALs 的独立危险因素，但不是 IVIG 抵抗的危险因素。Spearman 相关分析显示，CRP 与 MHR 呈正相关。
MHR 作为一种实用、经济的炎症标志物，对完全 KD 患儿合并 CALs 和 IVIG 抵抗具有显著的预测价值。在 KD 患儿中，更关注 MHR 的变化，有助于在临床实践中更好地了解 KD 的发展和预后。
