Predictive value of C-reactive protein to albumin ratio as a biomarker for initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients: a prospective cohort study

Xiaoliang Liu,Mei Wu,Lin Wang,Lei Liu,Shuran Shao,Chuan Wang,Yimin Hua,Kaiyu Zhou

doi:10.1186/s12969-021-00517-1

Abstract

BackgroundIntravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). This study aimed to prospectively investigated the value of C-reactive protein-to-albumin (CAR) in predicting both initial and repeated IVIG resistance in patients with KD, and to test the hypothesis that CAR was more valuable or accurate than either C-reactive protein (CRP) or albumin (ALB) alone in IVIG resistance prediction.MethodA prospective cohort study involving 550 patients with KD was conducted. The clinical and laboratory data were compared between IVIG-response group and IVIG-resistance group. Multivariate logistic regression analysis was performed to identify the independent risk factors of initial/repeated IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of CAR, CRP and ALB in predicting both initial and repeated IVIG resistance.ResultsCAR was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD. The best cut-off value of CAR for initial and repeated IVIG resistance prediction was 2.07 and 3.34, with a corresponding sensitivity of 0.610 and 0.548, a specificity of 0.552 and 0.813, respectively. The value of CAR was not better than either CRP or ALB alone for both initial and repeated IVIG resistance prediction.ConclusionA higher CAR was an independent risk factor for both initial and repeated IVIG resistance. However, similar with that of CRP or ALB, the predictive value of CAR was not good enough for both initial and repeated IVIG resistance prediction in KD.

Highlights

Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD)
C-reactive protein-to-albumin (CAR) was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD
Comparison of subjects between groups of initial IVIGresponse and IVIG-resistance As seen in Table 1, there was no significant difference between the two groups regarding gender proportion, body mass index (BMI) and fever duration before initial IVIG treatment, as well as typical clinical manifestations of KD

Summary

Introduction

Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). While timely initiation of therapy with intravenous immunoglobulin (IVIG) can effectively reduce the development of CALs [2], approximately 10– 20% patients do not respond to initial IVIG treatment and have a higher risk of CALs [3]. For children suffering from initial IVIG resistance, repeated IVIG infusion (2 g/Kg given as a single intravenous infusion) is recommended by many experts despite there are currently no robust evidences from clinical trials to guide the clinicians in the choice of therapeutic agents [4,5,6]. Because of the association between inflammation and KD development, it is supposed that the concentrations of most acute-phase proteins (APRs), which are those whose plasma concentration increases (positive APRs) or decreases (negative APRs) by at least 25% during inflammatory disorders [18], could be used to measure the state of systematic inflammation response in KD

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