Monocyte to HCL-C Ratio may help predict Kawasaki Disease in Children

Kawasaki disease (KD) is a childhood inflammatory condition that affects the blood vessels, particularly the coronary arteries, and can lead to serious complications such as coronary artery lesions (CALs) and resistance to intravenous immunoglobulin (IVIG) therapy. Identifying reliable biomarkers to predict the development and progression of KD-related complications is crucial for early intervention and improved patient outcomes.

A recent study published in European Journal Of Pediatrics by Jia-Ran Wang and colleagues aimed to investigate the predictive value of the monocyte to high-density lipoprotein cholesterol ratio (MHR) in complete KD patients for the occurrence of CALs and IVIG resistance. MHR is a practical, cost-effective inflammatory biomarker that has been shown to be a prognostic indicator in various cardiovascular diseases.

The study included a total of 207 children with complete KD. MHR values were calculated for each patient, and clinical characteristics and outcomes were analyzed. The differences in data between the groups with and without CALs and between IVIG-resistant and IVIG-responsive groups were compared. Spearman's correlation analysis was used to evaluate the relationship between C-reactive protein (CRP) and MHR. Multivariate logistic regression was performed to identify risk factors for CALs and IVIG resistance. Receiver operating characteristic (ROC) curve analysis determined the optimal MHR cut-off values and their predictive validity for CALs and IVIG resistance.

● The study found that MHR levels were significantly higher in the CAL+ group (patients with CALs) with an optimal cut-off value of 1.30 g/L, yielding a sensitivity of 0.753 and specificity of 0.805.

● The IVIG-resistant group showed elevated MHR levels with a cut-off value of 1.03 g/L, yielding a sensitivity of 0.97 and specificity of 0.485.

● Multivariate logistic regression confirmed that MHR was an independent risk factor for CALs but not for IVIG resistance.

● A positive correlation was observed between CRP and MHR levels.

The findings highlight the importance of MHR as a potential early indicator of KD complications, facilitating timely interventions and improved patient care. Healthcare professionals should pay close attention to MHR levels in children diagnosed with KD to better understand disease progression and prognosis in clinical practice.

The study suggests that MHR is a promising predictive biomarker for identifying complete KD children at risk of developing CALs and IVIG resistance. Monitoring changes in MHR levels may aid in early detection and improved management of KD-related complications.

Compared to other reported biomarkers, MHR exhibits practicality, cost-effectiveness, and higher sensitivity and specificity, making it a valuable tool in predicting outcomes in complete KD patients.

Reference:

Wang, J.-R., Zhao, H.-Z., Chang, L.-J., Xu, X., Gao, Y., Li, M., Kong, Q.-Y., Wang, M.-M., & Zhao, C.-F. (2023). Predictive value of monocyte to HCL-C ratio for coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease. European Journal of Pediatrics. https://doi.org/10.1007/s00431-023-05122-w