title: High neutrophil : lymphocyte ratio is associated with refractory Kawasaki disease.
abstract: BACKGROUND
  The clinical significance of the neutrophil : lymphocyte ratio (NLR) has not yet been fully elucidated in Kawasaki disease (KD). The purpose of this study was to investigate the relationship between NLR and response to i.v. immunoglobulin (IVIG), and its effect on coronary abnormalities in KD.
  
  
  METHODS
  A total of 196 KD patients treated with IVIG were analyzed. Baseline NLR was evaluated immediately before IVIG therapy and the patients classified into two groups according to NLR. The clinical data, other inflammatory biomarkers, and coronary complications were also assessed.
  
  
  RESULTS
  Kawasaki disease patients with NLR ≥ 5 had a greater incidence of IVIG refractoriness than the NLR < 5 group (31.7% vs 4.3%, P < 0.001), but this was not related to the development of coronary abnormalities. The change in NLR after IVIG (i.e. ΔNLR) was significantly decreased in the coronary abnormality group (2.65 ± 1.88 vs 3.81 ± 2.55, P = 0.042). On multivariate analysis, high NLR and CRP were independent predictors of IVIG refractoriness during the acute phase of KD (P = 0.032 in NLR; P = 0.029 in CRP, respectively).
  
  
  CONCLUSIONS
  High NLR was closely associated with resistance to IVIG, but it was not related to the occurrence of coronary abnormalities in KD. Low ΔNLR after IVIG, however, was significantly associated with coronary artery abnormalities.
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Hong-Je
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Bak
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Su Yeong
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Rita
authors.initials: R
authors.lastname: Yoo
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Hae-Sung
authors.initials: HS
authors.lastname: Baek
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Seung
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Il-Tae
authors.initials: IT
authors.lastname: Hwang
authors.affiliation: Department of Pediatrics, Hallym University Medical Center, Seoul, Korea.
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Ban
mesh_terms: D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D009504:Neutrophils / Q000378:metabolism*; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: Kawasaki disease; neutrophil : lymphocyte ratio