Skip to main content
SpringerLink
Log in

Predictive value of monocyte to HDL-C ratio for coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

A Correction to this article was published on 31 October 2023

This article has been updated

Abstract

We aimed to investigate the predictive validity of monocyte to high-density lipoprotein cholesterol ratio (MHR) for coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in complete Kawasaki disease (KD). MHR values of a total of 207 complete KD patients were calculated and analyzed with regard to their clinical characteristics and outcomes. We compared the differences in clinical data and laboratory parameters between CAL+ group and CAL- group as well as between IVIG-resistant group and IVIG-responsive group. Spearman’s correlation analysis was applied to evaluate the correlation between C-reactive protein (CRP) and MHR. Multivariate logistic regression was used to identify risk factors of CALs and IVIG resistance. Receiver operating characteristic (ROC) curve analysis was chosen to determine the optimal cut-off value of MHR and its validity in predicting CALs and IVIG resistance. The MHR level was significantly higher in the CAL+ group, with cut-off value of 1.30 g/L, yielding a sensitivity of 0.753 and specificity of 0.805, as well as in IVIG-resistant group, with cut-off value of 1.03 g/L, yielding a sensitivity of 0.97 and specificity of 0.485. Multivariate logistic regression showed that MHR was an independent risk factor for CALs but not for IVIG resistance. According to the Spearman’s correlation analysis, CRP was positively correlated with the MHR.

Conclusions: As a practical, cost-effective inflammatory biomarker, MHR has a significantly predictive value in complete KD children complicated with CALs and IVIG-resistance. Paying more attention to the changes of MHR in KD children may contribute to better understanding of KD development and prognosis in clinical practice.

What is Known:

• CALs are the most prevalent serious sequela of KD, and approximately 10%~20% of patients do not respond to IVIG therapy.

• MHR could be a convenient biomarker to predict the development and progression of CVDs. It has been reported that the MHR is a new prognostic biomarker in several CVDs.

What is New:

• MHR has a significantly predictive value in KD children complicated with CALs and IVIG-resistance.

• Compared with the molecular and immunological biomarkers that have been reported, MHR has the characteristics of practical, cost-effective, higher sensitivity and specificity, which can be used as a predictive indicator in complete KD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

No additional data are available.

Change history

Abbreviations

ALB:

Serum albumin

CALs:

Coronary artery lesions

CRP:

C-reactive protein

CVDs:

Cardiovascular diseases

HDL-C:

High-density lipoprotein cholesterol

IVIG:

Intravenous immunoglobulin

KD:

Kawasaki disease

LMR:

Lymphocyte-monocyte ratio

LDL-C:

Low-density lipoprotein cholesterol

MHR:

Monocyte-high density lipoprotein cholesterol ratio

MPV:

Peripheral mean platelet volume

MPVLR:

Platelet volume to lymphocyte ratio

NLR:

Neutrophil-lymphocyte ratio

PLR:

Platelet to lymphocyte ratio

TC:

Total cholesterol

TG:

Triglyceride

TB:

Total bilirubin

References

  1. Newburger JW, Takahashi M, Burns JC (2016) Kawasaki disease. J Am Coll Cardiol 67:1738–1749. https://doi.org/10.1016/j.jacc.2015.12.073

  2. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu M-H, Saji TT, Pahl E (2017) Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 135:e927-e999. https://doi.org/10.1161/CIR.0000000000000484

  3. Miyata K, Kaneko T, Morikawa Y, Sakakibara H, Matsushima T, Misawa M, Takahashi T, Nakazawa M, Tamame T, Tsuchihashi T, Yamashita Y, Obonai T, Chiga M, Hori N, Komiyama O, Yamagishi H, Miura M (2018) Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study. Lancet Child Adolesc Health 2:855–862. https://doi.org/10.1016/S2352-4642(18)30293-1

  4. Acikgoz N, Kurtoğlu E, Yagmur J, Kapicioglu Y, Cansel M, Ermis N (2018) Elevated monocyte to high-density lipoprotein cholesterol ratio and endothelial dysfunction in Behçet disease. Angiology 69:65–70. https://doi.org/10.1177/0003319717704748

  5. Murphy AJ, Woollard KJ, Hoang A, Mukhamedova N, Stirzaker RA, McCormick SPA, Remaley AT, Sviridov D, Chin-Dusting J (2008) High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol 28:2071–2077. https://doi.org/10.1161/ATVBAHA.108.168690

  6. Yvan-Charvet L, Pagler T, Gautier EL, Avagyan S, Siry RL, Han S, Welch CL, Wang N, Randolph GJ, Snoeck HW, Tall AR (2010) ATP-binding cassette transporters and HDL suppress hematopoietic stem cell proliferation. Science 328:1689–1693. https://doi.org/10.1126/science.1189731

  7. Ganjali S, Gotto AM, Ruscica M, Atkin SL, Butler AE, Banach M, Sahebkar A (2018) Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol 233:9237–9246. https://doi.org/10.1002/jcp.27028

  8. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, Karaman M, Oguz Y, Eyileten T, Vural A, Covic A, Goldsmith D, Turak O, Yilmaz MI (2014) Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 46:1619–1625. https://doi.org/10.1007/s11255-014-0730-1

  9. Zhang D-P, Baituola G, Wu T-T, Chen Y, Hou X-G, Yang Y, Pan Y, Ma X, Zheng Y-Y (2020) An elevated monocyte-to-high-density lipoprotein–cholesterol ratio is associated with mortality in patients with coronary artery disease who have undergone PCI. Biosci Rep 40(8):BSR20201108. https://doi.org/10.1042/BSR20201108

  10. Wu T-T, Zheng Y-Y, Chen Y, Yu Z-X, Ma Y-T, Xie X (2019) Monocyte to high-density lipoprotein cholesterol ratio as long-term prognostic marker in patients with coronary artery disease undergoing percutaneous coronary intervention. Lipids Health Dis 18:180. https://doi.org/10.1186/s12944-019-1116-2

  11. Akboga MK, Yayla C, Balci KG, Ozeke O, Maden O, Kisacik H, Temizhan A, Aydogdu S (2017) Relationship between serum albumin level and monocyte-to-high-density lipoprotein cholesterol ratio with saphenous vein graft disease in coronary bypass. Thorac Cardiovasc Surg 65:315–321. https://doi.org/10.1055/s-0036-1582260

  12. Aydin E, Ates I, Fettah Arikan M, Yilmaz N, Dede F (2017) The ratio of monocyte frequency to HDL cholesterol level as a predictor of asymptomatic organ damage in patients with primary hypertension. Hypertens Res 40:758–764. https://doi.org/10.1038/hr.2017.36

  13. Saskin H, Serhan Ozcan K, Yilmaz S (2017) High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 24:395–401. https://doi.org/10.1093/icvts/ivw376

  14. Bolayir A, Gokce SF, Cigdem B, Bolayir HA, Yildiz OK, Bolayir E, Topaktas SA (2018) Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 52:150–155. https://doi.org/10.1016/j.pjnns.2017.08.011

  15. Cagli K, Tok D, Turak O, Gunertem E, Yayla C, Lafci G, Ulas MM, Cagli K (2016) Monocyte count-to-high-density lipoprotein-cholesterol ratio is associated with abdominal aortic aneurysm size. Biomark Med 10:1039–1047. https://doi.org/10.2217/bmm-2016-0157

    Article  CAS  PubMed  Google Scholar 

  16. Uslu AU, Sekin Y, Tarhan G, Canakcı N, Gunduz M, Karagulle M (2018) Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 24:828–833. https://doi.org/10.1177/1076029617741362

  17. Tang X, Tan Y, Yang Y, Li M, He X, Lu Y, Shi G, Zhu Y, Nie Y, Li H, Mu P, Chen Y (2021) Association of the monocyte-to-high-density lipoprotein cholesterol ratio with diabetic retinopathy. Front Cardiovasc Med 8:707008. https://doi.org/10.3389/fcvm.2021.707008

  18. Sampath P, Moideen K, Ranganathan UD, Bethunaickan R (2018) Monocyte subsets: phenotypes and function in tuberculosis infection. Front Immunol 9:1726. https://doi.org/10.3389/fimmu.2018.01726

  19. Gratchev A, Sobenin I, Orekhov A, Kzhyshkowska J (2012) Monocytes as a diagnostic marker of cardiovascular diseases. Immunobiology 217:476–482. https://doi.org/10.1016/j.imbio.2012.01.008

  20. Hara T, Nakashima Y, Sakai Y, Nishio H, Motomura Y, Yamasaki S (2016) Kawasaki disease: a matter of innate immunity. Clin Exp Immunol 186:134–143. https://doi.org/10.1111/cei.12832

  21. Wang Z, Xie L, Ding G, Song S, Chen L, Li G, Xia M, Han D, Zheng Y, Liu J, Xiao T, Zhang H, Huang Y, Li Y, Huang M (2021) Single-cell RNA sequencing of peripheral blood mononuclear cells from acute Kawasaki disease patients. Nat Commun 12:5444. https://doi.org/10.1038/s41467-021-25771-5

  22. Ossoli A, Remaley AT, Vaisman B, Calabresi L, Gomaraschi M (2016) Plasma-derived and synthetic high-density lipoprotein inhibit tissue factor in endothelial cells and monocytes. Biochem J 473:211–219. https://doi.org/10.1042/BJ20151000

  23. Murphy AJ, Chin-Dusting JPF, Sviridov D, Woollard KJ (2009) The anti inflammatory effects of high density lipoproteins. Curr Med Chem 16:667–675. https://doi.org/10.2174/092986709787458425

    Article  CAS  PubMed  Google Scholar 

  24. Xie L-P, Yan W-L, Huang M, Huang M-R, Chen S, Huang G-Y, Liu F (2020) Epidemiologic features of Kawasaki disease in Shanghai from 2013 through 2017. J Epidemiol 30:429–435. https://doi.org/10.2188/jea.JE20190065

  25. Shao S, Zhou K, Liu X, Liu L, Wu M, Deng Y, Duan H, Li Y, Hua Y, Wang C (2021) Predictive value of serum lipid for intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease. J Clin Endocrinol Metab 106:e4210–e4220. https://doi.org/10.1210/clinem/dgab230

  26. Wu R, Jiang W, Sun Y, Wu L, Di Y, Wang J, Zhong S, Wang W (2023) Indicators of oxidative stress in the prediction of coronary artery lesions in patients with Kawasaki disease. JCR: J Clin Rheumatol 29:126–131. https://doi.org/10.1097/rhu.0000000000001925

  27. Yang C, Yang Y, Cao S, Ma Z, Du H, Li J, Dou F, Zhao Y, Li X, Hu X (2022) Kawasaki disease coronary artery lesions prediction with monocyte-to-high-density lipoprotein ratio. Pediatr Res. https://doi.org/10.1038/s41390-022-02401-4

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported in part by the grants from the Shandong Province Science and Technology project (2019GSF108186).

Author information

Author notes

  1. Jia-Ran Wang and Hai-Zhao Zhao contributed equally.

Authors and Affiliations

  1. Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China

    Jia-Ran Wang, Hai-Zhao Zhao, Lu-Jie Chang, Xue Xu, Yuan Gao, Meng Li, Qing-Yu Kong, Min-Min Wang & Cui-Fen Zhao

Authors
  1. Jia-Ran Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hai-Zhao Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lu-Jie Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xue Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuan Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Meng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qing-Yu Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Min-Min Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cui-Fen Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jia-Ran Wang, Hai-Zhao Zhao, and Cui-Fen Zhao contributed to the study design, formal analysis, and writing-original draft. Lu-Jie Chang and Xue Xu contributed to the data acquisition and curation. Qing-Yu Kong and Min-Min Wang contributed to the literature research. Meng Li and Yuan Gao revised the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Cui-Fen Zhao.

Ethics declarations

Ethical approval

The ethics committee of Qilu Hospital of Shandong University approved this research.

Consent to participate

Not necessary, in accordance with institutional ethic review board, due to retrospective study design.

Consent for publication

N/A.

Conflict of interest

The authors declare no conflict of interests.

Additional information

Communicated by Peter de Winter

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Abbreviation found in article title and keywords were corrected.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, JR., Zhao, HZ., Chang, LJ. et al. Predictive value of monocyte to HDL-C ratio for coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease. Eur J Pediatr 182, 4399–4406 (2023). https://doi.org/10.1007/s00431-023-05122-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-023-05122-w

Keywords

Search

Navigation