Predicting value of thrombospondin-2 for coronary artery dilatation in patients with Kawasaki disease

Abstract

To investigate the predictive value of thrombospondin-2 in children with coronary artery dilatation secondary to Kawasaki disease. This study was a retrospective controlled study, the patients were divided into Kawasaki disease group and control group.Patients first time hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics during the acute phase of Kawasaki disease were enrolled in Kawasaki disease group from May 2013 to August 2014.Sixty-four Kawasaki disease patients were enrolled into the Kawasaki disease group based on inclusion and exclusion criteria, including 39 males and 25 females, with an average age of 2.3 years.According to the results of echocardiography of children with Kawasaki disease, patients were divided into coronary artery dilatation group and non-coronary artery dilatation group, there were 33 cases in the coronary dilatation (CAD) group, 26 males and 7 females, the average age was 2.0 years, and 31 cases in the non-coronary dilatation (NCAD) group, 13 males and 18 females, the average age was 2.6 years.The control group consisted of children with fever but excluding vascular inflammatory diseases and healthy children, 32 cases in fever group, 19 males and 13 females, mean age was 4.5 years; in which healthy group had 32 cases, 18 males and 14 females and the average age was 3.3 years. Enzyme linked immunosorbent assay (ELISA) method was used to measure the levels of thrombospondin-1 (TSP-1) and TSP-2 in the plasma of each group, and the related laboratory parameters, and general information was analyzed.Multiple sets of normal distribution of data were compared by analysis of unifactorial analysis of variance and the two groups were compared by two independent samples t-test.Analysis of covariance was used to remove the effect of age.The χ(2) test was used to analyze categeorical data and receiver operating characteristic (ROC) curve for evaluating the predictive value of TSP-2. Compared with the febrile group and healthy group, plasma TSP-2 and TSP-1 of Kawasaki disease group was significantly elevated ((33.6±12.5) vs. (21.4±8.8) and (16.4±2.9) μg/L, (10 949±7 241) vs. (7 174±4 807) and (3 661±2 672) μg/L, F=36.861 and 17.339, P both<0.01). The TSP-2 concentration in the group with coronary artery dilatation was significantly higher than the group without it ((36.7±13.1) vs. (30.4±11.1)μg/L, t=2.062, P=0.043). Regarding the predictive effect of TSP-2 for coronary artery dilatation, sensitivity was 54.5%, specificity was 80.6%, and the cut-off point was 33.9 μg/L.When TSP-2 was combined with albumin<35 g/L to predict coronary artery dilatation, the area under the ROC curve was 0.701, sensitivity was 60.0%, specificity was 82.4%, and the cut-off point was 33.8 μg/L. During the acute phase of Kawasaki disease, TSP-2 levels were significantly elevated.It could be used to predict the occurrence of coronary artery dilatation.The predictive value of TSP-2 was significantly improved when combined with albumin.