Eosinophils Predicts Coronary Artery Dilatation and Long-term Prognosis in Children with Kawasaki Disease after Intravenous Immunoglobulin Therapy

Background: Coronary artery dilation is the main cause of poor prognosis in children with Kawasaki disease. Whether eosinophils can predict coronary artery dilation and long-term prognosis in children after intravenous immunoglobulin (IVIG) treatment for Kawasaki disease (KD). Methods: From January 2018 to December 2020, a total of 664 children with Kawasaki disease were continuously enrolled. Results: With a sensitivity of 77.78% and a specificity of 74.38%, the optimal cut-off value for predicting coronary artery dilatation is eosinophils ≥ 0.24. According to the cut-off value, the children were separated into two groups: eosinophils<0.24 group (n = 461) and eosinophils ≥ 0.24 group (n = 203). Eosinophils ≥ 0.24 as the ideal cut-off value for predicting cardiovascular death with an area under the curve (AUC) of 0.772 [95% confidence interval (CI): 0.720 ~ 0.823, P < 0.001], a sensitivity of 72.88%, and a specificity of 78.57%. The incidence of cardiovascular death, heart failure and multiple organ dysfunction was greater in the eosinophils ≥ 0.24 group, although there was no significant difference in the incidence of pericarditis procedures following IVIG between the two groups. Eosinophils ≥ 0.24 was also an independent predictor of cardiovascular death (hazard ratio = 4.95, 95% confidence interval (CI):2.98 ~ 8.23, P < 0.001). However, eosinophils have a lower sensitivity (23.08%) for predicting the recurrence of Kawasaki disease. Conclusion: eosinophils ≥ 0.24 was independently associated with coronary artery dilatation and poor clinical outcomes for children in Kawasaki disease after IVIG treatment.