Application of C-reactive Protein/Albumin Ratio (CAR) in Kawasaki Disease

Abstract Objective: To investigate the association between the C-reactive protein/albumin ratio (CAR) and coronary artery lesions (CAL), intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD).Methods: We retrospectively studied 753 children with KD, categorizing them into the CAL group(n=238) and the No-CAL group(n=515), the IVIG-resistance group(n=61) and the No-IVIG- resistance(n=653) group. The differences in laboratory data, clinical manifestations, the relationship between CAR and CAL as well as IVIG resistance were compared between the two cohort groups.Results: Compared with No-CAL group, KD with CAL had a higher CAR (2.12 vs 1.69, p <0.001). And CAR was significantly higher in KD children with IVIG resistance (2.42 vs 1.85, p<0.001). Multivariable logistic regression analysis demonstrated that higher CAR was a risk factors of CAL(OR=1.198, p<0.001) and IVIG resistance (OR=1.297, p<0.001), respectively. CAL and IVIG resistance interact with each other. ROC curve analysis performed for the prediction of CAL, the best cut-off point for CAR was 1.80(AUC=0.602, sensitivity 64.7%, specificity 54.8%). When predicting IVIG resistance according to the ROC curve analysis, the optimal cutoff point for CAR was 2.20(AUC=0.621, sensitivity 59.0%, specificity 61.1%).Conclusions: CAR is a valid indicator in KD children. Higher CAR may be helpful in predicting CAL and IVIG resistance in KD.