Abstract
We aimed to identify novel risk factors for the early prediction of coronary artery lesion (CAL) in children with Kawasaki disease (KD). We retrospectively analyzed data from hospitalized children newly diagnosed with KD between January 1, 2018, and December 31, 2020, with the following inclusion criteria: (1) diagnosis of KD, (2) first onset of CAL after admission, (3) with complete clinical records. Demographic and laboratory data were collected and analyzed. The independent risk factors of KD combined with CAL were identified by multivariate logistic regression analysis, followed by receiver operating characteristic (ROC) curve analysis to calculate the efficacy of identified risk factors in predicting KD combined with CAL. Among 241 initially recruited patients, 226 were eligible to be included in the study. Based on echocardiographic indications of CAL, 104 patients (46%) were assigned to the CAL (KD-CAL) group and 122 (54%) patients were assigned to the non-CAL (KD-nCAL) group. The levels of red blood cell count, red blood cell distribution width (RDW), C-reactive protein, tumor necrosis factor-α (TNF-α), and interleukin-6 were significantly higher in the KD-CAL group than those in the KD-nCAL group (all p < 0.05). RDW and TNF-α were found as independent risk factors of CAL occurrence. The sensitivity and specificity of RDW, TNF-α, and RDW + TNF-α in predicting KD with CAL were 67.31% and 79.51%, 74.04% and 73.77%, and 79.81% and 80.33%, respectively.
Conclusion: In conclusion, alterations in RDW and TNF-α levels can be used as novel biomarkers for early prediction of CAL in KD patients, although the differences in their absolute values were small and might not give any added value to echocardiography.
What is Known: •Known risk factors of CAL in children with KD include male gender and delayed use of intravenous immune globulin. | |
What is New: •Our current study identified that red blood cell distribution width (RDW) and tumor necrosis factor-α (TNF-α) are novel independent risk factors for predicting CAL combined with KD among patients. •The combination of these RDW and TNF-α together shows higher sensitivity and specificity than either one used alone. |
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The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
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Abbreviations
- CAL:
-
Coronary artery lesion
- KD:
-
Kawasaki disease
- TNF-α:
-
Tumor necrosis factor-α
- WBC:
-
White blood cell count
- NEUT#:
-
Absolute neutrophil count
- LYMPH#:
-
Absolute lymphocyte count
- MONO#:
-
Absolute monocyte count
- RBC:
-
Red blood cell count
- HGB:
-
Hemoglobin
- RDW:
-
Red blood cell distribution width
- PLT:
-
Platelet count
- PDW:
-
Platelet distribution width
- MPV:
-
Mean platelet volume
- CRP:
-
C-reactive protein
- IL-6:
-
Interleukin-6
- ESR:
-
Erythrocyte sedimentation rate
- ALT:
-
Alanine transaminase
- ALP:
-
Alkaline phosphatase
- TBIL:
-
Total bilirubin
- ALB:
-
Albumin
- CREA:
-
Creatinine
- Na:
-
Blood sodium
- K:
-
Blood potassium
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This work was funded by the Shanghai Municipal Science and Technology Commission (18411966600).
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Jie Li, Dong-e Li, Man Hu, Heyu Huang, Shanshan Xu, and Huajun Li conceived and designed the experiments; Jie Li, Dong-e Li, Man Hu, Heyu Huang, Shanshan Xu, and Huajun Li performed the experiments; Jie Li, Dong-e Li, Shanshan Xu, and Huajun Li analyzed and interpreted the data and contributed reagents, materials, analysis tools, or data; and Jie Li and Huajun Li wrote the paper.
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This study was approved by the Ethical Committee of The First Affiliated Hospital of USTC. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Li, J., Li, De., Hu, M. et al. Red blood cell distribution width and tumor necrosis factor-α for the early prediction of coronary artery lesion in Kawasaki disease: a retrospective study. Eur J Pediatr 181, 903–909 (2022). https://doi.org/10.1007/s00431-021-04252-3
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DOI: https://doi.org/10.1007/s00431-021-04252-3