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 2012-2016. 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 non-responder, and platelet count are significant predictors of CAA with a 95% confidence interval estimator of 1.999, 3.058, 3.864 and1.004, respectively. Using PNI to predict CAA presence gave an area under the receiver-operating-characteristics (ROC) curve of 0.596. For a cutoff of 0.5 in the logistic regression model and the PNI cut-off 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 non-responder. 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.

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.…”

“…However, some published articles suggest the importance of hematological indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and mean platelet volume (MPV)to-lymphocyte ratio (MPVLR) for predicting coronary involvement in KD [3,4,9,12]. Another parameter studied is the prognostic nutritional index (PNI), calculated by a formula including serum albumin level and lymphocyte count [16]. Systemic immune-inflammation index (SII), positively correlated with neutrophil, platelet counts and negatively correlated with lymphocyte counts, was studied recently in patients with cancer, coronary artery stenosis, and infective endocarditis [1,8,15].…”

Value of pretreatment prognostic nutritional index in predicting intravenous immunoglobin-resistant Kawasaki disease

“…In the present study, low PNI was associated with decreased albumin and/or lymphocytes. The patients with lower PNI had significantly higher the incidence of IVIG resistance in the present study, which was consistent with previous findings [18]. According to these results, PNI, combined with albumin and lymphocyte levels, could be a superior index that reflects inflammation, immune system and nutritional status in IVIG resistant KD.…”

“…Its prognostic value in various types of tumor, such as urinary cancer, tongue squamous cell carcinoma [9], osteosarcoma [10], gynecological cancer [11], non-small cell lung cancer [12] and pulmonary embolism [13], acute myocardial infarction [14,15], idiopathic dilated cardiomyopathy [16] and heart failure [17] has been widely investigated. Recently, Tai et al reported that a low pre-treatment PNI level (PNI<55) correlated to a high incidence of CALs, as well as IVIG non-responder in 275 children with KD from Taiwan [18], but the sample size was small and cases were came from only one institution. Therefore, the present study was designed in order to further determine whether PNI could predict IVIG resistance in large cohort of patients with KD from six institutions.…”

Complement 3 and Prognostic Nutritional Index Distinguish Kawasaki Disease from Fever Illness with Nomogram

“…Tai et al reported that PNI could be a candidate as an adjunctive predictor of CAL, as well as IVIG resistance. Together with low PNI, such factors as intravenous immunoglobulin (IVIG) resistance, male gender, and platelet count will contribute to high odds for predicting CAL within 6 months of illness (15).…”