Predictive value of C-reactive protein to albumin ratio in diagnosis of Kawasaki disease shock syndrome
Objective To identify the predictive validity of C-reactive protein to albumin ratio(CAR)in the early diagnosis of Kawasaki disease shock syndrome(KDSS).Methods This was a retrospective case-control study.Children with KDSS hospitalized in the Children's Hospital,Capital Institute of Pediatrics,from January 2019 to December 2022,were selected as the case group,and children with Kawasaki disease(KD)hospitalized in the same period were selected as the control group.After a 1:4 propensity score matching(PSM)of age and gender,the demographic characteristics,laboratory and imaging examinations,and other clinical data of all the patients were analyzed and compared between the two groups.Multivariate Logistic regression was used to analyze the possible risk factors of KDSS.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of risk factors for KDSS.Results There were 45 KDSS children and 269 KD children included in the study.The KDSS patients were older than the KD patients at the onset[43(19,51)months vs.24(14,44)months,Z=2.791,P＜0.05].After age-and gender-based PSM,there were 45 children in the KDSS group and 180 children in the KD group.The children with KDSS had a shorter duration of fever[6(4,6)days vs.6(5,7)days]and a higher risk of coronary artery lesions[42.22％(19/45)vs.25.56％(46/180)]compared to those with KD(Z=2.184,x2=4.868,all P＜0.05).Multivariate Logistic regression analysis showed that CAR,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,D-dimer,platelet count,serum sodium and estimated glomerular filtration rate were the independent risk factors for KDSS.The area under the ROC curve for identifying KDSS based on CAR was 0.850.When the cutoff value of CAR was 2.73,the sensitivity and specificity were 77.80％and 81.67％,respectively.After subgroup analysis,each one-unit increment in CAR was associated with a 239.6％increased risk of KDSS in children ≥ 3 years old(OR=3.396,95％CI:2.105-5.479,P＜0.05).Conclusions As one of the independent risk factors for KDSS,CAR has high predictive value for early diagnosis of KDSS.In KD patients ≥ 3 years old,the risk of developing KDSS increases significantly with increased CAR.
Kawasaki diseaseShockC-reactive protein to albumin ratio
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