Predictive value of clinical indices for intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease

Context: Intravenous immunoglobulin (IVIG) resistance and coronary artery
lesions (CALs) prediction are pivotal topic of interests in Kawasaki
disease (KD). However, data on the predictive value of lipid profile for
both IVIG resistance and CALs are limited. Purpose: To investigate the
predictive validity of lipid profile for IVIG resistance and CALs in KD.
Design: Prospective cohort study. Setting: West China Second University
Hospital. Patients: A total of 363 KD patients were divided into either
the initial IVIG-resistant group (n=56) and initial IVIG-responsive group
(n=307), or CAL+ group (n=61) and CAL- group (n=302). Patients suffering
initial IVIG resistance were further categorized into the repeated
IVIG-resistant group (n=33) and the repeated IVIG-responsive group
(n=23).  Main Outcome Measures: Validity of serum lipid profile
in predicting IVIG resistance and CALs. Results: Serum TG was
significantly higher (p=0.047) and TC (p=0.025), HDL-C (p<0.001),
LDL-C (p=0.021) as well as Apo A (p<0.001) were significantly lower
in initial IVIG-resistant subjects, with best cut-off values of 1.625
mmol/L, 3.255 mmol/L, 0.475 mmol/L, and 1.965 mmol/L and0.665 g/L,
yielding sensitivities of 52%, 70%, 52%, 61%, 50%, and specificities of
68%, 53%, 78%, 71%, 81% for initial IVIG resistance prediction,
respectively. TC (p=0.012), LDL-C (p=0.017), and Apo A (p=0.048) levels
were significantly lower in repeated IVIG-resistant subjects, with best
cut-off values of 3.20 mmol/L, 1.78 mmol/L, 0.605 g/L, producing
sensitivities of 91%, 70%, 57% and specificities of 55%, 67%, 70% for
repeated IVIG resistance prediction, respectively. Serum Apo-A level
(p=0.036) was significantly lower in the CAL group, with best cut-off
value of 0.805g/L, yielding a sensitivity of 66% and a specificity of 54%
for CAL prediction. Conclusions: Serum lipid profiles were significantly
dysregulated in KD patients suffering IVIG resistance and CALs. Some of
them, such as LDL-c and Apo-A, could serve as complementary laboratory
markers for the prediction of both IVIG resistance and CALs in KD.