Prognostic value of pretreatment prognostic nutritional index in intravenous immunoglobulin-resistant Kawasaki disease

The aim of the present study was to investigate the potential predictive significance of pretreatment prognostic nutritional index (PNI) in intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD). The PNI, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were analyzed in 1257 eligible patients with KD. Receiver operating curve analysis was used to explore the prediction accuracy for IVIG-resistant KD. The optimal cut-off values were identified as 49.5 for PNI, 3.58 for NLR and 164.00 for PLR, respectively. Lower pretreatment PNI (< 49.5) was demonstrated to be associated with lower age, serum sodium levels and platelet counts, and with a higher incidence of IVIG resistance and higher C-reactive protein levels. There was a significantly negative association between the PNI and NLR, and PLR. Univariate and multivariate analyses revealed that PNI, NLR and PLR were independent predictive factors for IVIG resistance. The discriminatory ability of PNI was not inferior to NLR, PLR and their combination (NLR > 3.58 and PLR > 164) for predicting IVIG resistance, respectively. Pretreatment PNI may serve as a novel surrogate independent predictor for IVIG-resistant KD.

Automated summary

The study demonstrated that the pretreatment PNI may serve as a novel predictor for IVIG-resistant KD. Lower PNI values were associated with IVIG resistance and related biochemical parameters. PNI, NLR, and PLR were identified as independent predictive factors for IVIG resistance.