Clinical utility of CBC-Derived inflammatory markers for predicting IVIG resistance: findings from a Korean infant Kawasaki disease cohort

초록

Background and objectives Kawasaki disease (KD) in infants presents unique clinical challenges, including higher rates of intravenous immunoglobulin (IVIG) resistance and coronary complications. This study aimed to evaluate the predictive value of inflammatory markers derived from complete blood count, specifically neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and pan-immune inflammation value (PIV), for IVIG resistance in infants under 12 months with KD. Methods A retrospective analysis was conducted on 261 infants diagnosed with KD between January 2014 and December 2024. The predictive performance of inflammatory markers was assessed using receiver operating characteristic curve analysis. Logistic regression analysis identified independent predictors of IVIG resistance. Results The IVIG resistance was observed in 67 patients (25.7%); MLR demonstrated the highest predictive accuracy (area under the curve [AUC] 0.776, 95% confidence interval [CI]: 0.706-0.845), followed by NLR (AUC 0.738, 95% CI: 0.670-0.806) and PIV (AUC 0.734, 95% CI: 0.658-0.811). Multivariate analysis identified MLR > 0.21 (odds ratio [OR] 3.45, 95% CI: 1.66-7.14), PIV > 726.68 (OR 2.30, 95% CI: 1.14-4.67), and elevated total bilirubin (OR 1.96, 95% CI: 1.02-3.79) as independent predictors. Coronary artery aneurysms were significantly more frequent in those IVIG-resistant (16.4% vs. 5.2%, p = 0.007). Conclusions MLR demonstrated moderate discriminative ability for predicting IVIG resistance in infant KD, suggesting its potential as a simple, cost-effective tool for early risk stratification in this vulnerable population.

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