C-reactive protein to albumin ratio (CRP/Alb), a novel marker of inflammation, may be a valuable predictor of the formation of coronary artery lesions and resistance to intravenous immunoglobulin in children with Kawasaki disease, according to research results published in Frontiers in Pediatrics.

The formation of coronary artery lesions is the most severe complication of Kawasaki disease. Although intravenous immunoglobulin may reduce this risk, coronary artery lesions still occur in 3% to 5% of children with Kawasaki disease.

In the current study, the researchers aimed to determine the predictive ability of CRP/Alb ratio in determining coronary artery lesions in patients with Kawasaki disease.


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The retrospective study included children diagnosed with Kawasaki disease at Kaohsiung Chang Gung Memorial Hospital, Taiwan, from January 2006 to December 2018. Patients were divided into 2 groups based on the presence of coronary artery lesions.

Multivariable logistic regression analysis was used to assess the independent risk factors for coronary artery lesions. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive ability of CRP/Alb ratio in predicting coronary artery lesions.

Of 410 patients with Kawasaki disease, 143 had coronary artery lesions and 267 had no evidence of coronary artery lesions. CRP/Alb ratio values were significantly higher in children with Kawasaki disease with coronary artery lesions compared with those with Kawasaki disease but without coronary artery lesions (3.14±3.17 vs 2.12±2.04, respectively; P <.001).

Multivariable logistic regression analysis identified several risk factors for predicting coronary artery lesions in children with Kawasaki disease, including male gender (odds ratio [OR], 3.222; P <.001), incomplete Kawasaki disease (OR, 1.968; P =.031), higher platelet count (OR, 1.004; P <.001), higher CRP levels (OR, 0.982; P =.048), and higher CRP/Alb ratio (OR, 1.994; P =.016).

Compared with patients with low CRP/Alb, those with CRP/Alb ratio of 2.94 or more had a higher risk for coronary artery lesions and intravenous immunoglobulin resistance (28.7% vs 49.6%, respectively; P <.001 and 11.6% vs 3.5%, respectively; P =.001). 

Researchers noted that future studies across multiple races and ethnicities are warranted to increase the generalizability of the results, as well as to investigate the superiority of high CRP/Alb ratio as a risk factor.

“This report is the first to show the role of CRP/Alb ratio in [children with Kawasaki disease],” the researchers concluded. “CRP/Alb ratio can serve as a novel predicting marker for [coronary artery lesion] formation and [intravenous immunoglobulin] resistance in [Kawasaki disease].”

Reference

Tsai CM, Yu HR, Tang KS, Huang YH, Kuo HC. C-reactive protein to albumin ratio for predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease. Front Pediatr. Published online November 25, 2020. doi:10.3389/fped.2020.607631