Predictive Value of the Systemic Immune-Inflammation Index for Intravenous Immunoglobulin Resistance and Cardiovascular Complications in Kawasaki Disease

Abstract

Background: The prediction of intravenous immunoglobulin (IVIG) resistance and cardiovascular complications are critically clinical issues in Kawasaki disease (KD). This prospective study firstly aimed to determine the predictive ability of the systemic immune inflammation index (SII) for IVIG resistance and cardiovascular complications and compare the prognostic accuracy of SII with that of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR).Methods: Patients with KD were divided into different groups according to the presence of IVIG resistance or cardiovascular complications (coronary artery lesions, valve regurgitation, myocarditis, pericardial effusion, and Kawasaki disease shock syndrome [KDSS]). The clinical and laboratory parameters were compared. Further analysis stratified by platelet level was performed. Multivariate logistic regression analysis was used to identify predictors for IVIG resistance and cardiovascular complications. The receiver operating characteristic (ROC) curve was applied to assess and compare the ability of SII, NLR, and PLR for predicting IVIG resistance and cardiovascular complications.Results: SII was significantly higher in KD patients with IVIG-resistance, myocarditis, valve regurgitation, and KDSS. It was identified as an independent risk factor for IVIG resistance, myocarditis, and valve regurgitation. For KD patients with thrombocytopenia, there were no significant differences in SII between KD patients with IVIG resistance/cardiovascular complications and those without. The best cutoff values of SII for IVIG resistance, myocarditis, valve regurgitation, and KDSS prediction in the whole cohort were 1331.4 × 109, 1368.6 × 109, 1002.4 × 109, and 1485.4 × 109, with a corresponding sensitivity of 0.525, 0.614, 0.754, and 0.670, a specificity of 0.711, 0.723, 0.584, and 0.730, respectively. The predictive value of SII for both IVIG resistance and cardiovascular complications were not superior to that of NLR.Conclusion: Although the parameter of SII may predict IVIG resistance, myocarditis, valve regurgitation, and KDSS in KD as a single parameter, its predictive ability was not good enough and not superior to NLR. SII might not be applicable in patients with KD having thrombocytopenia.

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

“…In the present study, IVIG-resistant patients had a higher SII and a lower decrease in its fluctuations pre- and post-treatment than IVIG-responsive patients. Additionally, a high SII after treatment was found to be significantly associated with IVIG resistance but not CAA development, which is consistent with the results of Liu et al [ 22 ] but not of Rumeysa et al [ 19 ], possibly because of the different days of detection of illness onset. Interestingly, our study found that patients with KD had a lower PNI, which is an index for nutritional assessment, both in the IVIG-resistant and CAA groups when compared to their respective counterparts, as in several previous studies [ 15 – 19 ].…”

“…Consistent with previous findings [ 5 , 21 , 46 , 52 – 54 ], our results showed that IVIG-resistant patients had a significantly higher NLR both pre- and post-treatment than IVIG-responsive patients. Notably, SII, which combines the NLR and platelet counts, was proposed as an independent risk factor for IVIG resistance and several cardiovascular complications in patients with KD; however, opposite findings were reported in subgroup analyses of patients with coronary artery lesions [ 19 , 22 ]. In the present study, IVIG-resistant patients had a higher SII and a lower decrease in its fluctuations pre- and post-treatment than IVIG-responsive patients.…”

“…Studies found that laboratory parameters shortly after IVIG treatment may be more helpful in identifying patients with KD who are at greater risk of CAA development and in guiding subsequent management as compared with those before IVIG infusion. Additionally, the fluctuations in the risk factors might possess greater predictive power for CAA development in patients with KD compared with baseline values [ 21 , 22 ]. Therefore, the present study focused on evaluating the clinical and laboratory characteristics of patients with KD before and after therapy who were grouped by responsiveness to the initial IVIG treatment and coronary status, and comparing the prognostic accuracy of risk factors with that of their fluctuations pre- and post-treatment.…”

Ultrasound evaluation of endothelial dysfunction in immunoglobulin-resistant children with acute Kawasaki disease

“…Several in ammatory laboratory parameters and cytokine markers have been reported to predict IVIG-resistant KD, but they may not be popular in clinical practice because they are invasive, expensive and lack reliability [5][6][7]. Several scoring systems proposed by Japanese researchers are also commonly used in the clinical identi cation of IVIG-resistant patients [8,9].…”

Value of blood inflammatory markers for predicting intravenous immunoglobulin resistance in Kawasaki disease: A systematic review and meta-analysis

“…Three additional articles were identified by screening the references of the retrieved full texts during primary screening. After the final screening against eligibility criteria, 22 papers were included in this study (Figure 1) (13)(14)(15)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38).…”