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Carella M, Magro D, Scola L, Pisano C, Guida E, Gervasi F, Giambanco C, Aronica TS, Frati G, Balistreri CR. CAR, mGPS and hs-mGPS: What is among them the best gero-biomarker for age-related diseases? And for what clinical application? Mech Ageing Dev 2024; 220:111952. [PMID: 38838917 DOI: 10.1016/j.mad.2024.111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024]
Abstract
The identification of biomarkers linked to the onset, progression, and prevention of age-related diseases (ARD), in the era of personalized medicine, represents the best goal of geroscience. Geroscience has the fundamental role of exploring and identifying the biological mechanisms of aging to suggest interventions capable of stopping/delaying the many pathological conditions and disabilities related to age. Therefore, it has become its key priority, as well as that of clinical practice and research, based on identifying and validating a range of biomarkers, geromarkers, which can be used to diagnostic, prognostic, or predictive clinical purposes. Indeed, geromarkers have, the potential to predict ARD trajectories and facilitate targeted interventions to slow down the related disabilities. Here our attention is paid to the inflammatory indexes (CAR, mGPS, hs-mGPS) linked to the relationship between the plasma levels of two inflammatory analytes, the typical positive protein of the acute phase, and the negative one, i.e. c-reactive protein (CRP) and albumin, respectively. These indexes allow us to understand the magnitude of the two main mechanisms predicted to influence the aging process, including inflammation and immunosenescence, as well as the degree of ARD severity. Evidence on their relationship with ARD is widely reported and discussed, to understand which can represent the best ARD geromarker, and its clinical application.
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Affiliation(s)
- Miriam Carella
- Complex Operative Unit of Clinical Pathology, ARNAS Civico Di Cristina e Benfratelli Hospitals, Palermo 90127, Italy
| | - Daniele Magro
- Cellular, Molecular and Clinical Pathological Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo 90134, Italy
| | - Letizia Scola
- Cellular, Molecular and Clinical Pathological Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo 90134, Italy
| | - Calogera Pisano
- Department of Precision Medicine in Medicine, Surgery, Critical Areas, University of Palermo, Palermo 90127, Italy
| | - Eugenia Guida
- Specialized Laboratory of Oncology, ARNAS Civico Di Cristina e Benfratelli Hospitals, Palermo 90127, Italy
| | - Francesco Gervasi
- Specialized Laboratory of Oncology, ARNAS Civico Di Cristina e Benfratelli Hospitals, Palermo 90127, Italy
| | - Caterina Giambanco
- Complex Operative Unit of Clinical Pathology, ARNAS Civico Di Cristina e Benfratelli Hospitals, Palermo 90127, Italy
| | - Tommaso Silvano Aronica
- Complex Operative Unit of Clinical Pathology, ARNAS Civico Di Cristina e Benfratelli Hospitals, Palermo 90127, Italy
| | - Giacomo Frati
- IRCCS Neuromed, Pozzilli, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Carmela Rita Balistreri
- Cellular, Molecular and Clinical Pathological Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo 90134, Italy.
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Zhang H, Cai J, Zhang R, Shuai S, Tang M, Ju R, Hu Y, Zuo T, Yang Y. The role of serum lipid in predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease: a cohort study. J Int Med Res 2024; 52:3000605241252115. [PMID: 38713460 PMCID: PMC11080733 DOI: 10.1177/03000605241252115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE To assess the predictive value of the serum lipid profile for initial intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in patients with Kawasaki disease (KD). METHODS This retrospective cohort study enrolled patients with KD and divided them into IVIG-responsive and IVIG-resistant groups. They were also stratified based on the presence of CALs (CALs and non-CALs groups). Clinical, echocardiographic and biochemical values were evaluated. A subgroup analysis was performed on complete and incomplete KD. Predictors of initial IVIG resistance and CALs were determined by multivariate logistic regression analysis. RESULTS A total of 649 KD patients were enrolled: 151 had CALs and 76 had initial IVIG resistance. Low-density lipoprotein cholesterol (LDL-C) was significantly lower in the IVIG-resistant group than in the IVIG-responsive group. LDL-C and apolipoprotein (Apo) B were significantly lower in the CALs group compared with the non-CALs group. Multivariate logistic regression failed to identify the serum lipid profile (LDL-C, Apo A or Apo B) as an independent risk factor for initial IVIG resistance or CALs in KD patients. CONCLUSION KD patients might have dyslipidaemia in the acute phase, but the serum lipid profile might not be suitable as a single predictor for initial IVIG resistance or CALs.
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Affiliation(s)
- Hongxi Zhang
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Jianghui Cai
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Department of Pharmacy, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Rui Zhang
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Shuping Shuai
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Mi Tang
- Department of Pharmacy, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Office of Good Clinical Practice, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Rong Ju
- Department of Paediatrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Ying Hu
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Tianrui Zuo
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Yanfeng Yang
- Department of Paediatrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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Liu J, Chen X, Yang M, Shen F, Zhu F, Jin J, Teng Y. C-reactive protein to albumin ratio as a prognostic tool for predicting intravenous immunoglobulin resistance in children with kawasaki disease: a systematic review of cohort studies. Pediatr Rheumatol Online J 2024; 22:42. [PMID: 38610057 PMCID: PMC11010335 DOI: 10.1186/s12969-024-00980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) is the primary treatment for Kawasaki disease (KD). However, 10-20% of KD patients show no response to IVIG treatment, making the early prediction of IVIG resistance a key focus of KD research. Our aim is to explore the application of the C-reactive protein to albumin ratio (CAR) for predicting IVIG resistance in children with KD through meta-analysis. METHODS Cochrane Library, PubMed, MEDLINE, EMbase, CNKI, WanFang, the Chinese Biomedical Database, and CQVIP were searched up to November 2023 for cohort studies on predicting IVIG-resistant KD using the CAR. Articles were selected based on pre-established inclusion and exclusion criteria after extracting literature data and assessing them using the QUADAS-2.0 tool for evaluating the accuracy of diagnostic tests. Stata 15.0 software was used for meta-analysis. RESULTS Four Chinese and English literature reports were included in this meta-analysis. The results revealed the presence of a threshold effect and high heterogeneity among the included studies. The combined sensitivity for CAR predicting IVIG-resistant KD was calculated as 0.65 (95% CI 0.58-0.72), specificity as 0.71 (95% CI 0.57-0.81), and the area under the curve (AUC) as 0.70 (95% CI 0.66-0.74) using the random-effects model. The combined positive likelihood ratio was 2.22 (95% CI 1.35-3.65), the combined negative likelihood ratio was 0.49 (95% CI 0.35-0.69), and the diagnostic odds ratio was 5 (95% CI 2-10). CONCLUSION CAR is an auxiliary predictive indicator with moderate diagnostic value that provides guidance in the early treatment of the disease, demonstrating a certain predictive value that warrants further investigation. However, CAR cannot yet be considered as a definitive diagnostic or exclusionary marker for IVIG-resistant KD. Therefore, multi-center, large sample, and high-quality long-term follow-up trials are warranted to confirm the current findings.
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Affiliation(s)
- Jue Liu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Xingguang Chen
- Department of orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Minling Yang
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Fangfang Shen
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Feng Zhu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Jian Jin
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
| | - Yiqun Teng
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
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Shuai S, Zhang H, Zhang R, Tang M, Luo E, Yang Y, Gao Y, Yue S, Liang H, Cai J. Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study. J Pediatr (Rio J) 2023; 99:406-412. [PMID: 36977496 PMCID: PMC10373155 DOI: 10.1016/j.jped.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Since coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD), clinically speaking, early prediction of CALs is crucial. The authors aimed to investigate the predictive value of C-reactive protein (CRP) in predicting CALs in KD patients. METHODS KD patients were divided into the CALs group and the non-CALs group. The clinical and laboratory parameters were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of CALs. The receiver operating characteristic curve was applied to determine the optimal cut-off value. RESULTS 851 KD patients who met the inclusion criteria were studied, including 206 in the CALs group and 645 in the non-CALs group. Children in the CALs group had significantly higher CRP levels than the non-CALs group (p < 0.05). Multivariable logistic regression analysis showed that incomplete KD, male, lower hemoglobin, and higher CRP were independent risk factors for predicting CAL (all p < 0.05). The optimal cut-off value of initial serum CRP for predicting CALs was 105.5 mg/L, with a sensitivity of 47.57% and a specificity of 69.61%. In addition, KD patients with high CRP (≥105.5 mg/L) had a higher occurrence of CALs than those with low CRP (<105.5 mg/L) (33% vs 19%, p < 0.001). CONCLUSION The incidence of CALs was significantly higher in patients with high CRP. CRP is an independent risk factor for CALs formation and may be useful for predicting CALs in KD patients.
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Affiliation(s)
- ShuPing Shuai
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - HongXi Zhang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Rui Zhang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Mi Tang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu, China; University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Office of Good Clinical Practice, Chengdu, China
| | - ErDan Luo
- University of Electronic Science and Technology of China, School of Medicine, Chengdu, China; University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Office of Good Clinical Practice, Chengdu, China
| | - YanFeng Yang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pediatric Cardiology, Chengdu, China
| | - Yu Gao
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - ShanLan Yue
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Hua Liang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - JiangHui Cai
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China.
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Zhang R, Shuai S, Zhang H, Cai J, Cui N, Tang M, Xing S, Gao Y, Liu X, Yang X. Predictive value of albumin for intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients. Ital J Pediatr 2023; 49:78. [PMID: 37357258 DOI: 10.1186/s13052-023-01482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) has been the mainstay of treatment for Kawasaki disease (KD) over the past decades. However, 10-20% of KD patients are resistant to IVIG treatment which puts those patients at high risk of coronary artery lesions (CALs). Therefore, it is important to predict whether patients will be resistant to IVIG before the treatment. This study aimed to investigate the risk factors for IVIG non-responsive patients with KD. METHODS This study enrolled patients diagnosed with KD and divided them into two groups, IVIG responders and IVIG non-responders. We compared the differences in demographics and clinical data between the two groups. Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS In total, 907 KD patients were reviewed, with 841 IVIG responders and 66 IVIG non-responders. Patients in IVIG responders were younger than IVIG non-responders. The length of hospitalization of the IVIG non-responders was significantly longer than IVIG responders. The neutrophils%, C-reaction protein (CRP), and CRP/albumin ratio in IVIG responders were significantly lower than in IVIG non-responders (P < 0.05). The lymphocyte% and Albumin in IVIG responders were significantly higher than in IVIG non-responders. Multivariable logistic regression analysis demonstrated that albumin (OR = 0.881, 95% CI, 0.781 to 0.994, p-value = 0.039) was an independent risk factor for predicting IVIG resistance. The area under the ROC curve was 0.644, with a cut-off of ≤ 33.4 g/L determined by Youden's index. The sensitivity and specificity in predicting IVIG resistance were 40.91% and 83.47%, respectively. CONCLUSION Albumin can serve as a potential predicting marker for IVIG resistance in KD. A lower albumin level may be useful for identifying KD patients with a high risk of IVIG resistance to guide further therapy strategies.
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Affiliation(s)
- Rui Zhang
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Shuping Shuai
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hongxi Zhang
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jianghui Cai
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Na Cui
- Department of Emergency, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Mi Tang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
- Office of Good Clinical Practice, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Shasha Xing
- Office of Good Clinical Practice, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yu Gao
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xia Liu
- Department of Pharmacy, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiao Yang
- Department of Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, No.1314 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
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Liu J, Ye B, Su D, Qin S, Zhao W, Pang Y. Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy. Clin Rheumatol 2023; 42:167-177. [PMID: 36129563 PMCID: PMC9491265 DOI: 10.1007/s10067-022-06366-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We aimed to evaluate the clinical and laboratory characteristics of patients with Kawasaki disease (KD) before and after therapy. METHODS Patients with KD were divided into different groups according to their responsiveness to initial intravenous immunoglobulin (IVIG) treatment and coronary status. The clinical and laboratory parameters before and after therapy were compared. Multivariate analysis was performed to identify the independent risk factors, and the receiver operating characteristic (ROC) curve was applied to assess and compare the prediction ability of risk factors and their fluctuations. RESULTS Of the 153 patients included in the study, 41 (26.8%) had IVIG resistance and 37 (24.2%) had developed CAA. After stratifying by therapy response, the two groups differed in the levels of total bilirubin (TSB), albumin, and sodium, neutrophil-to-lymphocyte count ratio (NLR), platelet-to-lymphocyte count ratio (PLR), TSB-to-albumin (B/A) ratio, and prognostic nutritional index (PNI) before IVIG, and in the white blood cell count (WBC), neutrophil count, levels of hemoglobin, C-reactive protein (CRP), alanine aminotransferase (ALT), and albumin, NLR, PNI, capillary leakage index (CLI), and systemic immune-inflammation index (SII) after IVIG. Multivariate analysis revealed that the B/A ratio before IVIG and CLI and SII after IVIG were significantly and positively associated with IVIG resistance and that there was a larger decline in the B/A ratio and smaller decline in CLI and SII pre- and post-treatment in the IVIG-resistant group than in the IVIG-responsive group. However, no statistical differences in the fluctuations of the B/A ratio, CLI, and SII as well as all parameters before and after therapy were observed in patients with and without CAA. ROC curve analyses found a greater AUC value of post-treatment parameters (0.751 and 0.706 for CLI and SII, respectively) compared with pre-treatment parameters (0.654 for B/A ratio) in predicting IVIG resistance; however, the predictive ability of the fluctuations in risk factors before and after therapy was not superior to that of baseline values. CONCLUSIONS The B/A ratio before IVIG and CLI and SII after IVIG were risk factors for IVIG resistance in patients with KD, independent of CAA development. Key Points • A high total bilirubin-to-albumin ratio before IVIG and high capillary leakage and systemic immune-inflammation indices after IVIG may indicate an increased risk of intravenous immunoglobulin resistance in patients with Kawasaki disease. • Post-treatment parameters were superior to pre-treatment parameters in terms of prediction; therefore, rapid and repeated assessment of risk factors before and after treatment must be considered in children in whom the vital signs and symptoms do not improve after treatment.
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Affiliation(s)
- Jie Liu
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Bingbing Ye
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Danyan Su
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Suyuan Qin
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Weiying Zhao
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Yusheng Pang
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
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Liu C, Wu J. Value of blood inflammatory markers for predicting intravenous immunoglobulin resistance in Kawasaki disease: A systematic review and meta-analysis. Front Pediatr 2022; 10:969502. [PMID: 36081627 PMCID: PMC9445314 DOI: 10.3389/fped.2022.969502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies have assessed the diagnostic accuracy of blood inflammatory markers like neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP), and CRP to albumin ratio (CAR) to predict the resistant Kawasaki disease (KD). The aim of the current meta-analysis and systematic review is to compare the prognostic ability of these inflammatory markers to predict the resistance to IVIG in patients with Kawasaki disease. METHODS A systematic search of online academic databases and search engines such as EMBASE, PubMed Central, MEDLINE, Cochrane library, Google Scholar, and ScienceDirect was conducted for papers that report the diagnostic accuracy of inflammatory markers for resistant KD. Meta-analysis was performed using STATA software. RESULTS Twenty-two studies met the inclusion criteria. Pooled sensitivity and specificity of NLR as a predictor of resistant Kawasaki disease was 72% (95% CI: 62%, 80%) and 71% (95% CI: 63%, 78%), with AUC of 0.77 for PLR was 60% (95% CI: 50%, 69%) and 68% (95% CI: 61%, 75%), with area under the curve (AUC) of 0.69. Pooled sensitivity and specificity of CRP was 75% (95% CI: 68%, 81%) and 66% (95% CI: 55%, 76%), respectively, with an AUC value of 0.78. Pooled sensitivity and specificity of combined NLR and PLR was 58% (95% CI: 46%, 69%) and 73% (95% CI: 65%, 79%), respectively, with an AUC value of 0.72. CONCLUSION Our study found that NLR, CRP, PLR, and combined NLR/PLR have a good prognostic value in patients with resistant Kawasaki disease, with moderate to high sensitivity and specificity. More research on the accuracy of these indexes in multiple combinations is needed. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022322165].
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Affiliation(s)
- Chang Liu
- Department of Pediatrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiacheng Wu
- Department of Urology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, China
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Lu Y, Chen T, Wen Y, Si F, Wu X, Yang Y. Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease. BMC Pediatr 2021; 21:406. [PMID: 34530763 PMCID: PMC8444587 DOI: 10.1186/s12887-021-02876-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. METHODS A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. CONCLUSIONS Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.
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Affiliation(s)
- Yaheng Lu
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Tingting Chen
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Yizhou Wen
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Feifei Si
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Xindan Wu
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China.
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Overexpressed Neuropilin-1 in Endothelial Cells Promotes Endothelial Permeability through Interaction with ANGPTL4 and VEGF in Kawasaki Disease. Mediators Inflamm 2021; 2021:9914071. [PMID: 34434074 PMCID: PMC8380503 DOI: 10.1155/2021/9914071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
Disrupted endothelial permeability plays a crucial role in the vasculitis pathogenesis of Kawasaki disease (KD), which leads to pathological vascular leak and facilitates inflammatory cell infiltration in vascular lesions; however, the mechanisms involved in the development of endothelial barrier dysfunction during KD vasculitis are still largely unclear. Here, we found that sera from patients with KD can induce endothelial cell (EC) hyperpermeability compared to sera from healthy controls. We observed that serum vascular endothelial growth factor (VEGF) levels were increased in KD patients and sera from KD patients upregulated the expression of VEGF receptor 2 (VEGFR2) and neuropilin-1 (NRP1) in human coronary artery endothelial cells (HCAECs). Intriguingly, compared with silence of VEGFR2 in HCAECs, NRP1 silence resulted in a marked decrease in EC permeability. Furthermore, soluble NRP1 (sNRP1) remarkably reduced the stimulation of EC permeability by sera from KD patients compared with bevacizumab treatment. Importantly, we showed that besides VEGF, angiopoietin-like-4 (ANGPTL4), a NRP1-binding vasoactive factor, was also increased in KD and contributed to the EC permeability in KD conditions. In addition, levels of both ANGPTL4 and VEGF were inversely correlated with albumin levels in the serum of KD patients. Collectively, the data demonstrated that overexpressed NRP1, along with upregulated VEGFR2, in HCAECs treated with KD sera promotes endothelial permeability via interaction with the increased ANGPTL4 and VEGF in KD. Neutralization of hyperpermeability factors by sNRP1 may be a novel therapeutic strategy for KD vasculitis.
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Liu X, Zhou K, Hua Y, Wang C. Letter to the editor regarding "Value of C-reactive protein/albumin ratio in predicting intravenous immunoglobulin-resistant Kawasaki disease - A data from multi-institutional study in China". Int Immunopharmacol 2021; 95:107632. [PMID: 33903075 DOI: 10.1016/j.intimp.2021.107632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China; Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China; Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China; Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China; Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Li G, Wang T, Gou Y, Zeng R, Liu D, Duan Y, Liu B. Letter to the editor regarding "Value of C-reactive protein/albumin ratio in predicting intravenous immunoglobulin-resistant Kawasaki disease - A data from multi-institutional study in China". Int Immunopharmacol 2021; 95:107631. [PMID: 33896753 DOI: 10.1016/j.intimp.2021.107631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Gang Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
| | - Ting Wang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Yongying Gou
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Rumeng Zeng
- Neonatal Department, Dujiangyan Medical Center, Sichuan, China
| | - Dong Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Yan Duan
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Bin Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
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