Association Between the Persistency and Severity of Mitral Regurgitation and the Hematologic Z-Values of Inflammatory Biomarkers in Kawasaki Disease.

BACKGROUND AND

objectivesValvulitis is frequently found in Kawasaki disease (KD). However, the persistence and severity of mitral regurgitation (MR) in KD are not well-known. This study examined the correlation between MR and z-values of inflammatory serum biomarkers.

methodsPatients with KD at Korea University Hospital over 15-year period were retrospectively investigated. Echocardiography and inflammatory serum biomarkers were examined in 371 patients with KD (241 with MR and 130 without) and 144 patients with febrile illness (control). Serum biomarkers (raw and z-values) were compared among the positive, negative, all, and no MR groups during each phase of KD.

resultsNeutrophil, z-neutrophil, lymphocyte, z-lymphocyte, neutrophil-lymphocyte ratio, hemoglobin, z-hemoglobin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) all differed significantly between the positive and negative MR groups and between the all and no MR groups during the acute phase (p<0.05). A part of white blood cell (WBC), z-WBC, neutrophil, z-neutrophil, neutrophil to lymphocyte ratio, hemoglobin, z-hemoglobin, CRP, ESR, aspartate transaminase, and sodium were associated with severity of MR through correlation analysis and multivariate logistic regression (p<0.05). Optimal cut-off values of neutrophils, z-neutrophils, CRP, and ESR to predict persistent MR were 8,100 /μL, 2.2, 61 mg/dL, and 77 mm/h.

conclusionsA comparison of hematological z-values in KD with MR and in KD without MR is useful for predicting more severe inflammation. Neutrophils, z-neutrophils, and ESR were significant and consistently associated with pathogenesis of MR and their levels during the early inflammation can predict the persistency and severity of MR.