Neutrophil-to-Lymphocyte Ratio as Predictor of Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Mini Systematic Review

Author : A. Prabata
Upload Date : 19-04-2018

Background: Kawasaki Disease (KD) is systemic vascular inflammation which can lead to coronary artery abnormalities (CAA). Intravenous immunoglobulin (IVIG) has become effective treatment for preventing CAA in KD, but approximately 10-20% of patients are resistant. Neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, was introduced as novel and useful predictor for IVIG-resistance in KD, although the clinical significance has not yet been elucidated. We aim to investigate the effectiveness of NLR as predictor for IVIG-resistance in KD.

Methods: We made structured search in several databases including Pubmed, Sciencedirect, Springerlink, and EBSCOHost for cohort studies in this topic. Then, the selected prognosis studies underwent critical appraisal based on Oxford CEEBM prognosis study critical appraisal.

Results: Four retrospective cohort studies comprising of 1605 participants met all inclusion criteria were critically appraised. All of studies shown that NLR can be predictor value which is statistically significant (p<0.001). The cut-off point of NLR value is ranged from 3.83-5.49. Odds Ratio (OR) is ranged from 2.96-5.94. Sensitivity and specificity are ranged from 39.0%-72.0% and 67.0%-86%. Positive predictive value (PPV) and negative predictive value (NPV) are ranged from 37.0%-63.0% and 70.0% and 90.0%. Diagnostic accuracy of NLR as IVIG-resistance predictor is ranged from 67.0%-68.0%.

Conclusion: This review shown that NLR was closely associated with IVIG resistance in KD. Because of its wide availability, simplicity, and inexpensiveness, it can be an important predictor in the future for IVIG resistance in KD with more research.

KEYWORDS : neutrophil to lymphocyte ratio, kawasaki disease, intravenous immunoglobulin resistance

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