An assessment of neutrophil percentage‑to‑albumin ratio in Kawasaki disease.

BACKGROUNDS: Kawasaki disease (KD) is an immune vasculitis of unknown etiology. Coronary artery lesions (CALs) and intravenous immunoglobulin resistance (IVIGR) are two major clinical challenges in KD. Previous studies had pointed out that neutrophil percentage‑to‑albumin ratio (NPAR) was associated with the prognosis of cardiac diseases. However, its role in KD has not been fully explored.

METHODS

We enrolled patients with the main diagnosis of KD admitted to Children's Hospital of Soochow University between December 2018 and June 2024. Patients were stratified into tertiles based on NPAR, and comparisons among groups were conducted. Univariate and multivariable logistic regression were carried out. Restricted cubic splines and fitted curves were used to examine the relationships between NPAR and the presence of CALs and IVIGR. Subgroup analyses were also investigated.

RESULTS

A total of 2371 patients were included in the present study. The incidences of IVIGR and CALs were 12.9% (305/2371) and 28.3% (670/2371), respectively. Patients with higher NPAR levels exhibited higher incidences of IVIGR. In contrast, NPAR was not associated with CALs. A positive linear relationship was noted between NPAR and IVIGR (p < 0.001). The expected presence of IVIGR was also positively related to NPAR. However, the association was modified by age and coronary artery status.

CONCLUSIONS

NPAR may serve as a prognostic indicator for IVIGR, particularly in patients younger than 48 months and those without CALs, but not for CALs.