Predictive value of lymphocyte-to-C-reactive protein ratio for predicting initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease: a prospective cohort study

Abstract

Lmphocyte-to-C-reactive protein ratio (LCR) has tremendous predictive power for diseases with similar pathogenesis to Kawasaki disease (KD). The evidence on the prognostic value of LCR for IVIG resistance, especially for repeated IVIG resistance in KD, remains scarce. We conducted a prospective cohort study comprising 1607 individuals with KD to evaluate the predictive value of LCR for both the initial and repeated IVIG resistance. A comparison was made between the initial/repeated IVIG-resistance group and the initial/repeated IVIG-response group. We found that LCR was markedly reduced in both initial and repeated IVIG non-responders and was an independent risk factor for forecasting both initial and repeated IVIG resistance in KD. The optimal cut-off values of LCR for predicting initial and repeated IVIG resistance were 0.042 × 10⁹ and 0.025 × 10⁹, respectively, with sensitivities of 74.1% and 51.3% and specificities of 65.9% and 55.8%. LCR may be a complementary laboratory marker for predicting initial and repeated IVIG resistance to guide clinical management. What is Known: • Lmphocyte-to-C-reactive protein ratio (LCR) has tremendous predictive power for diseases with similar pathogenesis to Kawasaki disease (KD). However, the evidence on the prognostic value of LCR for IVIG resistance, especially for repeated IVIG resistance in KD, remains scarce. What is New: • LCR may be a complementary laboratory marker for predicting initial and repeated IVIG resistance to guide clinical management.

Keywords: Intravenous immunoglobulin resistance; Kawasaki disease; Lymphocyte-to-C-reactive protein ratio; Prediction.