Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease.

Jinxin Wang,Xuting Zhang,Rongzhou Wu,Maoping Chu,Yiping Shao,Jiawen Li,Xing Rong,Hongying Shi,Huixian Qiu,Yue Ren

doi:10.1155/2020/8743548

Abstract

Objective To investigate the association between the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT ratio, AAR) and intravenous immunoglobulin (IVIG) resistance, coronary artery lesions (CAL), and coronary artery aneurysms (CAA) in children with Kawasaki disease (KD). Design We retrospectively studied 2678 children with KD and divided them into two groups: a low-AAR group and a high-AAR group with a median AAR of 1.13 as the cut-off point. The differences in laboratory data, clinical manifestations, and coronary artery damage rates were compared between the two groups. Results The incidence of CAL was higher in the low-AAR group than in the high-AAR group at 2 and 3-4 weeks after illness onset (p < 0.001, respectively). The IVIG resistance rate was significantly higher in the low-AAR group than in the high-AAR group (29.94% vs 21.71%, p < 0.001). The levels of C-reactive protein, erythrocyte sedimentation rate, white blood cell count, bilirubin, fibrinogen, thrombin time, D-dimer, and brain natriuretic peptide were also significantly higher in the low-AAR group compared with the high-AAR group. The levels of albumin and IgG were significantly lower in the low-AAR group compared with those of the high-AAR group. The proportion of typical KD cases in the low-AAR group was significantly higher than that in the high-AAR group. Low-AAR correlated with the risk of coronary artery damage and IVIG resistance. Conclusion Children with KD who had low-AAR value were more likely to develop coronary artery damage and IVIG resistance. Low AAR is a risk factor for CAL, CAA, and IVIG resistance in KD.

Highlights

Kawasaki disease (KD) has been reported for more than 50 years [1], its etiology is unknown
We reviewed the data of children with KD at the Second Affiliated Hospital of Wenzhou Medical University from 1 January 2011 to 31 December 2018
The proportion of atypical KD was lower in the low-AST/ALT ratio (AAR) group than in the high-AAR group (17.72% vs 31.55%, p < 0.001)

Summary

Introduction

Kawasaki disease (KD) has been reported for more than 50 years [1], its etiology is unknown. Its pathological features include extensive inflammation of small and medium blood vessels throughout the body. E major serious complication of KD is coronary artery lesions (CAL). Despite receiving intravenous immunoglobulin (IVIG) therapy timely, coronary artery aneurysms (CAAs) occur in 4% of patients with KD [2], and are the leading cause of acquired heart disease. Transaminase has been used as a monitoring indicator of liver function for several decades and as a basic laboratory test in clinical practice [13]. Aspartate aminotransferase (AST) is widely found in the liver, kidney, brain, lung, and skeletal muscle, whereas alanine aminotransferase (ALT) is mainly present in the hepatocyte cytoplasm. When hepatocytes are damaged by acute inflammation, the cell

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Discussion

Conclusion