Índice neutrófilos linfocitos y plaquetas linfocitos como predictores de refractariedad al tratamiento con inmunoglobulina intravenosa en enfermedad de Kawasaki en el Hospital de niños Roberto Gilbert desde el año 2013 al 2025.

Abstract

Introduction: Kawasaki disease is the leading cause of acquired heart disease in childhood. Resistance to IVIG treatment increases the risk of coronary damage, necessitating tools to predict refractoriness. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio emerge as useful and easily applicable biomarkers. Objective: To evaluate the predictive capacity of NLR and PLR for IVIG resistance and coronary lesions in Kawasaki disease. Materials and Methods: Observational, analytical, retrospective study of 157 KD patients (2013-2025) at Roberto Gilbert E. Childrens Hospital. Treatment resistance was defined according to AHA criteria. Diagnostic performance of NLR and PLR, prior to IVIG administration, was analyzed using ROC curves and logistic regression. In a post hoc exploratory analysis, stratification was performed by age and evolution time. Results: In the study population (n=157), the INL and IPL, alone or in combination, showed little predictive value for the development of refractoriness and coronary artery disease (CAD). CAD and elevated AST values were identified as independent predictors. In infants under 12 months of age with early-onset disease (n=26), the combination of both indices, INL ≥1.53 and IPL ≥82.37, demonstrated predictive power for refractoriness (OR=20; 95% CI 1.80-223). Similar predictive power (OR=20) was observed for coronary lesions with cutoff points of INL ≥1.58 and IPL ≥92.7 Conclusions: Inflammatory indices do not predict refractoriness and coronary complications; however, their usefulness could be accepted in infants under 12 months of age with early disease.