Prognostic nutrition index as a predictor of coronary artery aneurysm in Kawasaki Disease

Abstract

Background: Kawasaki Disease (KD) is considered a major acquired heart disease in children under the age of 5. Coronary artery aneurysm (CAA) can occur in serious cases despite extreme therapy efforts. Previous studies have reported low serum albumin level was associated with disease outcome, but no further investigation was addressed yet. Method: This retrospective (case-control) study randomly included children with KD who were admitted and underwent laboratory tests before undergoing IVIG treatment in this institution, the largest tertiary medical center in southern Taiwan from 2012 to 2016. Prognostic nutrition index (PNI), an albumin-based formula product, was evaluated as a predictor of CAA the first time. The progression of CAA was monitored using serial echocardiography for six months. We performed multivariable logistic regression analysis on the laboratory test and PNI with the disease outcome of the KD patients. Result: Of the 275 children, 149 had CAA, including transient dilatation, while the other 126 did not develop CAA during the 6-month follow-up period. A multivariate logistic regression model revealed that PNI, gender, IVIG nonresponder, and platelet count are significant predictors of CAA with a 95% confidence interval estimator of 1.999, 3.058, 3.864 and 1.004, respectively. Using PNI to predict CAA presence gave an area under the receiver-operatingcharacteristics (ROC) curve of 0.596. For a cutoff of 0.5 in the logistic regression model and the PNI cutoff point is taken as 55 together with IVIG non-responder, boy gender, and platelet count take into account, sensitivity and specificity were 65.7 and 70.4%. Conclusion: PNI could be a candidate of adjunctive predictor of coronary artery aneurysm in addition to IVIG nonresponder. Together with low PNI, IVIG non-responder, male gender and platelet count will give high odds to predict coronary artery aneurysm within 6 months of illness.

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

“…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][16][17][18][19]. It is worth noting that the lowest PNI value in the IVIG-resistant group occurred on day 6, which corresponds to the highest SII value in the present study (Supplementary Fig.…”

“…Studies have discovered that among high-risk patients for initial IVIG resistance, the incidence of adverse coronary artery outcomes has been significantly reduced by adding corticosteroids or cyclosporine to standard-dose IVIG and aspirin in the primary treatment of KD [13,14]; therefore, studies are necessary to uncover novel parameters in the prediction of IVIG resistance among patients with KD. Given that a single risk factor for IVIG resistance is not necessarily transferable among populations, parameters merging the risk factors, such as the prognostic nutritional index (PNI) and systemic immune-inflammation index (SII), were correlated with increased incidence of IVIG resistance and CAA development and may have better discriminatory ability than any indicator alone, as reported in the past two years [15][16][17][18][19][20]; nevertheless, these results remain controversial. Moreover, most studies used data acquired before IVIG treatment, and few studies have included laboratory data both before and after treatment and taken into consideration the dynamic changes in these predictors.…”

Is There a Role for Laboratory Parameters in Predicting Coronary Artery Involvement in Kawasaki Disease?

“…A study that compared PNI levels of KD patients with and without coronary aneurism found that PNI was a predictor for coronary aneurism. They detected a cut off point of PNI with the level of 55.24, with a sensitivity of 50% and a specificity of 67.8% 16 . In our study, similar to the previous one, PNI was lower in patients with CALs.…”

Establishment and Validation of a Multivariate Predictive Scoring Model for Intravenous Immunoglobulin-Resistant Kawasaki Disease: A Study of Children From Two Centers in China

“…PNI also reflects the inflammatory condition of the body to some extent ( 34 ). Moreover, it has also been shown that low pre-treatment PNI levels (PNI < 55) can be used as an adjunctive predictor of CAL ( 35 ). In this scoring model, peripheral blood PNI was scored 1 point, where peripheral blood PNI consisted of two indicators, namely serum ALB and peripheral blood lymphocytes.…”