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Value of cystatin C for Kawasaki disease with coronary artery aneurysm
Kaizhi Liang1, Danyan Su1, Yusheng Pang1
1Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Elevated cystatin C levels before intravenous immunoglobulin treatment may predict coronary artery aneurysm in Kawasaki disease. Early cystatin C measurements show promise for identifying patients at higher risk.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Rheumatology
Background:
- Cardiovascular and kidney diseases share biological pathways.
- Renal function in Kawasaki disease (KD) requires further investigation.
- Coronary artery aneurysm (CAA) is a severe cardiac complication of KD.
Purpose of the Study:
- To evaluate cystatin C (Cys C) and other laboratory markers for predicting CAA in KD patients.
- To assess the predictive value of Cys C before and after intravenous immunoglobulin (IVIG) treatment.
- To identify independent risk factors for CAA development in KD.
Main Methods:
- Retrospective analysis of 122 KD patients categorized by coronary status.
- Multivariate logistic regression to identify independent risk factors for CAA.
- Receiver operating characteristic (ROC) curves to assess predictive values of parameters.
Main Results:
- 23% of KD patients developed CAA; 9.8% showed coronary artery regression.
- Pre-IVIG Cys C was identified as an independent risk factor for CAA (OR=10.183).
- A Cys C cut-off value of 0.71 within five days showed 100% sensitivity for CAA prediction (AUC=0.752).
Conclusions:
- Higher pre-IVIG Cys C levels are associated with increased CAA risk in KD.
- Early Cys C measurement (within five days) may enhance prediction of CAA development.
- Further large-scale prospective studies are needed to confirm Cys C's predictive utility.
Background:
Cardiovascular and kidney diseases are interconnected through shared biological mechanisms. However, research on renal function in Kawasaki disease (KD) remains insufficient. This study focused on coronary artery aneurysm (CAA), a severe cardiac consequence of KD, aiming to examine the predictive value of cystatin C (Cys C) and other common laboratory indicators before and after intravenous immunoglobulin (IVIG) treatment on KD with CAA.
Methods:
Based on patients' coronary status, 122 KD individuals were categorized in this retrospective analysis. After comparing the clinical and laboratory information of the patients with KD, multivariate logistic regression analysis was employed to identify independent risk factors for CAA development among them. Additionally, the predictive values of these parameters in CAA development of KD were assessed by receiver operating characteristic (ROC) curves.
Results:
In this study, 28 patients (23.0%, 28/122) had CAA, including 12 who had coronary artery regression (9.8%, 12/122). The parameters with P<0.10 in the difference analysis, namely polymorphous exanthem, changes in the extremities, plateletocrit and Cys C before IVIG, prealbumin >107.2 mg/L and prognostic nutritional index >54.7 after IVIG, were included in multivariate logistic regression analysis. Finally, binary logistic regression analysis identified the pre-IVIG Cys C [odds ratio, 10.183; 95% confidence interval (CI): 1.158-89.525] as an independent risk factor for developing CAA among KD patients. In addition, the 0.71 Cys C cut-off value sampled within five days had a 100% sensitivity and a 42.9% specificity (area under the ROC curve =0.752, 95% CI: 0.577-0.928, P=0.03).
Conclusions:
Higher pre-IVIG Cys C levels may be associated with increased CAA risk, but further large-scale prospective studies are needed to confirm its predictive utility. Furthermore, Cys C acquired within five days of disease onset may theoretically provide better prediction power for the CAA development in KD.
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