Ulu Kadir, Çağlayan Şengül, Coşkuner Taner, Vazgeçer Ebru Oğultekin, Öner Taliha, Sözeri Betül
Department of Pediatric Rheumatology, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences, Emek-Namık Kemal Avenue No. 54, 34785, Sancaktepe, Istanbul, Turkey.
Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Pediatr Cardiol. 2025 Jun;46(5):1390-1399. doi: 10.1007/s00246-025-03785-w. Epub 2025 Jan 28.
The study sought to assess the clinical utility of complete blood count-derived composite scores, suggesting their potential as markers of inflammation and disease severity in Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with Kawasaki-like features. This retrospective study analyzed data from 71 KD and 73 MIS-C patients and 70 healthy controls. The KD group showed a higher rate of coronary involvement (26.7% vs. 10.9%), while the MIS-C group had a higher intensive care unit (ICU) admission rate (34.2% vs. 2.8%). Platelet counts, lymphocyte counts, mean platelet volume (MPV), MPV/Lymphocyte (MPVLR), and MPV/Platelet (MPVPR) ratios demonstrated the highest specificities in distinguishing MIS-C than KD (84.5%, 83.1%, 91.1%, 88.7%, and 88.7%, respectively). Monocyte counts, MPV, and MPVPR demonstrated the highest specificities to predictive ICU admission in the MIS-C group (83.3%, 89.6%, and 89.6%, respectively). Lymphocyte counts, platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), MPVLR, and Systemic Immune-Inflammation Index (SII) parameters were found to have high negative predictive values for predicting KD patients without coronary artery lesions (CALs) (85.7%, 86.1%, 87.1%, 87.1%, and 85.7%, respectively)., Systemic Inflammation Response Index (SIRI), MPVPR, and CRP were independently predictive of ICU admission in the MIS-C group, and lymphocyte count and IVIG resistance were also identified as significant predictors of CALs in the KD group. NLR, MPVLR, MPVPR, and NPR indices effectively differentiate MIS-C from KD and predict ICU admission in MIS-C. NLR, PLR, MPVLR, and SII are valuable in excluding CALs in KD with high negative predictive values. In addition, SIRI and MPVLR were independent predictors of ICU admission in MIS-C, and lymphocyte count was identified as an independent predictor of CALs in KD.
该研究旨在评估全血细胞计数得出的综合评分的临床实用性，表明其作为川崎病（KD）以及具有川崎样特征的儿童多系统炎症综合征（MIS-C）中炎症和疾病严重程度标志物的潜力。这项回顾性研究分析了71例KD患者、73例MIS-C患者和70名健康对照者的数据。KD组冠状动脉受累率更高（26.7%对10.9%），而MIS-C组重症监护病房（ICU）入住率更高（34.2%对2.8%）。血小板计数、淋巴细胞计数、平均血小板体积（MPV）、MPV/淋巴细胞（MPVLR）和MPV/血小板（MPVPR）比值在区分MIS-C与KD方面表现出最高的特异性（分别为84.5%、83.1%、91.1%、88.7%和88.7%）。单核细胞计数、MPV和MPVPR在MIS-C组中对预测ICU入住表现出最高的特异性（分别为83.3%、89.6%和89.6%）。发现淋巴细胞计数、血小板/淋巴细胞比值（PLR）、中性粒细胞/淋巴细胞比值（NLR）、MPVLR和全身免疫炎症指数（SII）参数对预测无冠状动脉病变（CALs）的KD患者具有较高的阴性预测值（分别为85.7%、86.1%、87.1%、87.1%和85.7%）。全身炎症反应指数（SIRI）、MPVPR和CRP是MIS-C组ICU入住的独立预测因素，淋巴细胞计数和静脉注射免疫球蛋白抵抗也被确定为KD组CALs的重要预测因素。NLR、MPVLR、MPVPR和NPR指数可有效区分MIS-C与KD，并预测MIS-C患者的ICU入住情况。NLR、PLR、MPVLR和SII在以高阴性预测值排除KD患者的CALs方面具有重要价值。此外，SIRI和MPVLR是MIS-C组ICU入住的独立预测因素，淋巴细胞计数被确定为KD组CALs的独立预测因素。
