Changes of immune and inflammation related indexes in children with Kawasaki disease at acute stageand their relationships with prognosis

  Objective  To analyze the changes of CD64 on the surface of neutrophils, growth differentiation factor-15 (GDF-15) and serum amyloid A (SAA) in children with Kawasaki disease (KD) at acute phase and their relationships with prognosis.

  Methods  The clinical materials of 105 children with KD at acute phase (KD group) in authors'hospital were retrospectively analyzed, and 110 healthy children with physical examination in the same period were selected as control group. Children in the KD group were treated with immunoglobulin (IVIG) after admission, and the levels of CD64 on the surface of neutrophils in the peripheral blood, GDF-15 and SAA were compared between the KD group and the control group. According to the condition of coronary artery lesions (CAL) at 3 months after onset, the children were divided into CAL group and non-CAL group, and the levels of CD64 on the surface of neutrophils in the peripheral blood, GDF-15 and SAA were compared between the two groups before treatment. Receiver operating characteristic (ROC) curve was used to evaluate the value of the above indicators in predicting the occurrence of CAL in children with KD.

  Results  After treatment, the levels of CD64 on the surface of neutrophils in the peripheral blood, GDF-15 and SAA in the KD group were significantly lower than those before treatment, and the levels of above indicators before and after treatment in the KD group were significantly higher than those in the control group (P < 0.05). In the KD group, the incidence rate and severity of CAL at the early onset were significantly higher than those at 3 months after onset (P < 0.05). The levels of CD64 on the surface of neutrophils in the peripheral blood, GDF-15 and SAA before treatment in the CAL group (n=31) were significantly higher than those in the non-CAL group (n=74) (P < 0.05). ROC curve analysis showed that the levels of CD64 on the surface of neutrophils in the peripheral blood, GDF-15 and SAA before treatment had high predictive values for CAL in children with KDarea under the curve (AUC)=0.632, 0.846, 0.775, P < 0.05, and their cut-off values were 78.60%, 1 655.39 ng/mL and 795.41 mg/L, and the combination of the three indexes had the highest predictive values for prognosis (AUC=0.908, P < 0.05).

  Conclusion  The CD64 on the surface of neutrophils, GDF-15 and SAA may be involved in the progression of KD at acute phase, and their levels before treatment can predict incidence of CAL in children with KD at 3 months after onset.