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. 2021 Mar 12;19(1):24.
doi: 10.1186/s12969-021-00517-1.

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  1   2   3 , Lin Wang  4 , Kaiyu Zhou  1   2   3   5 , Shuran Shao  1   6 , Yimin Hua  1   2   3   5 , Mei Wu  1   6 , Lei Liu  1   6 , Chuan Wang  7   8   9   10
Affiliations

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 et al. Pediatr Rheumatol Online J. .

Abstract

Background: Intravenous 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.

Method: A 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.

Results: CAR 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.

Conclusion: A 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.

Keywords: C-reactive protein to albumin ratio; Intravenous immunoglobulin resistance; Kawasaki disease.

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Conflict of interest statement

None of authors declared any conflict of interests.

Figures

Fig. 1
Fig. 1
The flowchart of our prospective cohort study. In total, 763 patients were diagnosed with KD on admission. Those who had received IVIG treatment in other medical facilities (n = 126) or did not receive IVIG treatment before 10 days from fever onset (n = 38) were firstly excluded. Another 30 patients were also excluded due to lack of data regarding complete blood count (CBC) or CRP (n = 18) or serum ALB (n = 12) before initial IVIG. Additionally, we excluded 19 patients because other laboratory data (n = 10) or follow-up results (n = 9) were incomplete. Finally, 550 patients were enrolled for analysis, including 471 of initial IVIG responders and 79 of initial IVIG non-responders. Of the 79 patients with initial IVIG resistance, 31 of them did not respond to repeated IVIG treatment and received pulse intravenous methylprednisolone infusion
Fig. 2
Fig. 2
The receiver operating characteristic (ROC) curve for CAR, C-reactive protein and serum albumin in predicting initial IVIG resistance
Fig. 3
Fig. 3
The receiver operating characteristic (ROC) curve for CAR, C-reactive protein and serum albumin in predicting repeated IVIG resistance
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