Value of C-reactive Protein/albumin Ratio in Predicting Intravenous Immunoglobulin-Resistant Kawasaki Disease- a Data from Multi-Institutional Study in China.

Background: C-reactive protein/albumin ratio (CAR) is associated with inflammation. However, it prognostic value for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) has scarcely investigated. Methods: A 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). Results: High 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). Conclusions: CAR 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.y