The use of neutrophil–lymphocyte ratio for the prediction of refractory disease and coronary artery lesions in patients with Kawasaki disease

Abstract Background: Kawasaki disease is a vasculitis that can lead to cardiac complications, including coronary artery disease and cardiogenic shock. Various scoring systems have been developed to determine those that will be refractory to routine intravenous immunoglobulin therapy or develop coronary artery disease. The objective of this study was to determine if the neutrophil–lymphocyte ratio could predict refractory disease and coronary artery lesions in patients with Kawasaki disease. Methods: A systematic review of the literature was performed to identify manuscripts describing comparisons of neutrophil–lymphocyte ratio between those who had refractory disease and those who did not, and between those who developed coronary artery lesions and those who did not. Mean difference was compared between groups. Areas under the curve were utilised to determine the pooled area under the curve. Results: 12 studies with 5593 patients were included in the final analyses of neutrophil–lymphocyte ratio for the prediction of refractory disease. Neutrophil–lymphocyte ratio before therapy was higher in refractory disease with a mean difference of 2.55 (p < 0.01) and pooled area under the curve of 0.724. Neutrophil–lymphocyte ratio after therapy was higher in refractory disease with a mean difference of 1.42 (p < 0.01) and pooled area under the curve for of 0.803. Five studies with 1690 patients were included in the final analyses of neutrophil–lymphocyte ratio for the prediction of coronary artery lesions. Neutrophil–lymphocyte ratio before therapy was higher in coronary artery lesions with a mean difference of 0.65 (p < 0.01). Conclusion: The use of neutrophil–lymphocyte ratio may help physicians in the identification of patients at risk of refractory disease and coronary artery lesions in patients with Kawasaki disease.