Value of C-reactive protein/albumin ratio in predicting intravenous immunoglobulin-resistant Kawasaki disease- a data from multi-institutional study in China

Abstract

BackgroundC-reactive protein/albumin ratio (CAR) is associated with inflammation. However, it prognostic value for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) has scarcely investigated. MethodsA total of 957 patients with KD including 159 IVIG-resistant patients and 798 with IVIG-responsive patients between Jun 2013 and August 2019 were reviewed and the laboratory records were compared between IVIG-resistant patients and IVIG-responsive patients. Univariate and multivariate logistic analysis were performed to determine the independent predictors of IVIG resistance. A receiver operating characteristic curve analysis was conducted to compare the predictive accuracy between CAR and the combination of neutrophil-to-lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). ResultsHigh CAR was associated with high the incidence of IVIG-resistance, anemia and coronary artery lesions, and high levels of neutrophils, CRP, aspartate aminotransferase, NLR, PLR, and erythrocyte sedimentation rate, and associated with low levels hemoglobin, albumin and lymphocytes count (all p < 0.05). The CAR (OR: 1.33, CI: 1.09–1.57), NLR (OR: 1.02, CI: 1.002–1.039) and PLR (OR: 1.004, CI: 1.003–1.005) were independent predictors for IVIG-resistance. CAR has superior discriminatory ability for IVIG resistance when compared with combination of NLR and PLR (z = 2.575, p = 0.01). ConclusionsCAR prior to IVIG treatment could be a novel prognostic marker for IVIG resistant KD. CAR was superior to the combination of NLR and PLR for predicting IVIG resistant KD.