Exploring the diagnostic value of eosinophil-to-lymphocyte ratio to differentiate Kawasaki disease from other febrile diseases based on clinical prediction model

Guo, Xin; Liao, Jinwen; Fan, Xue; Xu, Mingkai

doi:10.1038/s41598-023-30463-9

Cited by 5 publications

(7 citation statements)

References 45 publications

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“…The role of ELR was also paid attention in various infections 9 , 10 and cancer. 12 , 22 The ELR value was lower in pneumonic COVID‐19 patients than that with non‐pneumonic COVID‐19 infection, contrary to the NLR value 23 In the present study, ELR was significantly decreased in non-survivors than that in survivors, suggesting that ELR is a useful biomarker for distinguish the in-hospital mortality in CAP.…”

Section: Discussioncontrasting

confidence: 60%

“…11 Guo et al showed that ELR was significantly increased in patients with Kawasaki disease (KD). 12 In addition, a retrospective study found that peripheral blood eosinophil counts and the eosinophil-to-monocyte ratio (EMR) at admission in pediatric patients with COVID-19 were significantly lower than those in healthy children. 13 Recent studies have evaluated the prognostic value of EMR in patients with ST elevated myocardial infarction, 14 acute ischemic stroke, 15 and pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

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EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

Sun,

Wang,

et al. 2024

IDR

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Background Data about eosinophil-to-lymphocyte ratio (ELR) and eosinophil-to-monocyte ratio (EMR) in patients with community-acquired pneumonia (CAP) are rare. We aimed to evaluate the role of EMR and ELR in predicting disease severity and mortality in patients with CAP. Methods A total of 454 patients (76 with severe CAP (SCAP), 378 with non-SCAP) were enrolled from November 18, 2020, and November 21, 2021. Laboratory examination on day 1 after admission was measured. The ELR and EMR values were calculated for patients. Propensity score matching (PSM) was performed to balance potential confounding factors. Binary logistic regression model was fitted to identify the potential risk factors for disease severity and Cox proportional hazards regression model analysis for mortality in CAP. Receiver operating characteristic (ROC) analysis was performed to distinguish disease severity and mortality. Results EMR and ELR at admission were significantly lower in SCAP patients than in non-SCAP patients ( P <0.001). EMR < 0.018 ([OR] = 12.104, 95% CI: 4.970–29.479), neutrophil (NEU) ([OR]=1.098, 95% CI:1.005–1.199), and age ([OR]=1.091, 95% CI:1.054–1.130) were independent risk factors for disease severity of CAP. EMR < 0.032 ([HR] = 5.816, 95% CI: 1.704–9.848) was an independent predictor of in-hospital mortality. Combining EMR or ELR with CRB-65 improved the overall accuracy of disease severity prediction (AUC from 0.894 to 0.937), the same as CURB-65. The area under the curve of EMR (AUC=0.704; 95% CI: 0.582–0.827) to predict in-hospital mortality was higher than that of CURB-65 (AUC=0.619; 95% CI: 0.484–0.754). Otherwise, EMR combined with CRB-65 (AUC=0.721; 95% CI: 0.592–0.851) had significantly higher diagnostic accuracy for in-hospital mortality than that of CURB-65 alone. Conclusion EMR combined with CRB-65 was superior to CURB-65 in predicting mortality in patients with CAP. This new combination was simpler and easier to obtain for physicians in clinics or admission, and it was more convenient for early recognition of patients with poor prognoses.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

Sun,

Wang,

et al. 2024

IDR

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“…The range of cutoff values in the studies differentiating KD-CAL from KD-NCAL falls between 31.5 and 55. 24. The range of cutoff values in the studies differentiating IVIG-resistant from IVIG-responsive KD patients fell between 47.8 and 52.4.…”

Section: Discussionmentioning

confidence: 96%

“…The summarized characteristics of the included studies are presented in Table 1. From 2020 to 2023, a total of 8 articles containing 10 studies were eligible (15)(16)(17)(18)(21)(22)(23)(24). The majority of these studies were conducted in mainland China (8/10), one study from Taiwan, China, and one from Turkey.…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Values of prognostic nutritional index for predicting Kawasaki disease: a systematic review and meta-analysis

Zhong,

Xie,

Wang

et al. 2024

Front. Nutr.

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ObjectiveThis systematic review and meta-analysis aimed to evaluate the relationship between the prognostic nutritional index (PNI) and intravenous immunoglobulin (IVIG) resistance and coronary artery lesion (CAL) in Kawasaki disease (KD).MethodsThe relevant literature was searched on PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar up to August 5, 2023. A pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under curve (AUC) were calculated to assess the predicted values of PNI in KD patients with IVIG resistance and CAL.ResultsA total of 8 articles containing 10 studies involving 7,047 participants were included. The pooled results revealed a pooled sensitivity of 0.44 (0.25–0.65), a pooled specificity of 0.87 (0.73–0.94), a pooled PLR of 3.4 (2.0–5.9), a pooled NLR of 0.65 (0.48–0.87), a pooled DOR of 5.26 (2.76–10.02), and a pooled AUC of 0.75 (0.71–0.78) in the diagnosis of KD with CAL. The pooled results suggested that a pooled sensitivity was 0.69 (0.60–0.77), specificity was 0.76 (0.69–0.82), PLR was 2.9 (2.1–4.1), NLR was 0.40 (0.29–0.56), DOR was 7.27 (3.89–13.59), and AUC was 0.79 (0.75–0.82) in the diagnosis of KD with IVIG resistance. The combined results revealed the pooled sensitivity was 0.63 (0.58–0.67), specificity was 0.82 (0.80–0.83), PLR was 3.09 (1.06–8.98), NLR was 0.38 (0.07–2.02), DOR was 8.23 (0.81–83.16) in differentiating KD from febrile patients. These findings demonstrated low sensitivity and relatively high specificity of PNI for KD, KD-CAL, and IVIG-resistant KD.ConclusionIn conclusion, this study was the first systematic review and meta-analysis of the diagnostic value of PNI in KD with IVIG resistance and CAL. The results suggested that PNI could be used as biomarkers for distinguish KD, KD with CAL, and KD with IVIG resistance.

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“…Mast cells and eosinophils are known to create feedback loops. The eosinophil-to-lymphocyte ratio is a useful diagnostic for KD [ 102 ]. Immune responses to infectious pathogens are likely associated with overlapping symptoms.…”

Section: Discussionmentioning

confidence: 99%

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

Ricke,

Smith

2024

Life

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Background: Vasculitis diseases include Kawasaki disease (KD), Kawasaki disease shock syndrome (KDSS), Multisystem Inflammatory Syndrome (MIS), Henoch–Schönlein purpura (HS), or IgA vasculitis, and additional vasculitis diseases. These diseases are often preceded by infections or immunizations. Disease incidence rates are higher in children than in adults. These diseases have been extensively studied, but understanding of the disease etiology remains to be established. Objective: Many studies have failed to demonstrate an association between vasculitis diseases and vaccination; this study examines possible associations. Methods: Herein, the Vaccine Adverse Event Reporting System (VAERS) database is retrospectively examined for associations between vasculitis diseases and immunizations. Results: For some vaccines, the number of rare cases of KD, MIS, and HS are higher than the background rates. These rare cases are predicted to occur in individuals with (1) genetic risk factors with (2) antibody titer levels above the primary immune response level. Herein, the model of humoral immune response antibodies bound to antigens (pathogen or vaccine) creating immune complexes is proposed. These immune complexes are proposed to bind Fc receptors on immune cells and platelets, resulting in cell activation and the release of inflammatory molecules including histamine and serotonin. Immune complexes and inflammatory molecules including serotonin and histamine likely trigger vasculitis. Elevated serotonin and possibly histamine drive initial vasoconstrictions, disrupting blood flow. Increased blood flow pressure from cardiac capillary vasoconstrictions is predicted to trigger coronary artery aneurysms (CAA) or lesions (CAL) in some patients. For KDSS and MIS patients, these cardiac capillary vasoconstrictions are predicted to result in ischemia followed by ventricular dysfunction. Ongoing ischemia can result in long-term cardiac damage. Cases associated with pathogens are likely to have persistent infections triggering disease onset. Conclusion: The proposed model of immune complexes driving disease initial disease etiology by Fc receptor activation of immune cells and platelets, resulting in elevated histamine and serotonin levels, is testable and is consistent with disease symptoms and current treatments.

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Exploring the diagnostic value of eosinophil-to-lymphocyte ratio to differentiate Kawasaki disease from other febrile diseases based on clinical prediction model

Cited by 5 publications

References 45 publications

EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

EMR Combined with CRB-65 Superior to CURB-65 in Predicting Mortality in Patients with Community-Acquired Pneumonia

Values of prognostic nutritional index for predicting Kawasaki disease: a systematic review and meta-analysis

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

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