C-reactive protein to high density lipoprotein cholesterol ratio for predicting coronary artery lesions, and intravenous immunoglobulin resistance in Kawasaki disease

BACKGROUND: Coronary artery lesion (CAL) in children with Kawasaki disease (KD) is a major acquired heart disease. This study aims to investigate the C-reactive protein to high-density lipoprotein cholesterol (CRP/HDL-C) ratio as a predictor of CAL and intravenous immunoglobulin (IVIG) resistance in KD. METHODS: We analyzed 203 children with KD hospitalized at Qilu Hospital from January 2016 to July 2023. Based on the presence of CAL, all children with KD were categorized into two groups: KD with CAL group (KD-CAL, n = 87) and KD without CAL group (KD-nonCAL, n = 116). Similarly, according to their response to IVIG, they were classified into the IVIG-resistance group (n = 28) and the IVIG-sensitive group (n = 175). Statistical analyses included Student’s t-test, Mann-Whitney U test, and χ² test. The predictive efficacy of the CRP/HDL-C ratio was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Children with KD who developed CAL had significantly elevated CRP and lower HDL-C levels than those without CAL (P < 0.001). The CRP/HDL-C ratio was significantly higher in the KD-CAL group than in the KD-nonCAL group [median (IQR): 159.94 (57.07-225.63) vs. 54.89 (19.50-81.19); Z = 7.146, P < 0.001]. ROC curve analysis showed that this ratio had a sensitivity of 55.2% and a specificity of 87.1% for diagnosing CAL, with an AUC of 0.793 (P < 0.001). Furthermore, the incidence of CAL was significantly higher in the IVIG-resistant group than in the IVIG-sensitive group (χ²=4.229, P = 0.04). Consistent with this, the CRP/HDL-C ratio was also significantly elevated in the IVIG-resistant group (Z = 2.162, P = 0.031). For predicting IVIG resistance, the ratio yielded a sensitivity of 46.4%, a specificity of 84.6%, and an AUC of 0.627 (P = 0.031). CONCLUSIONS: Children with KD who developed either CAL or IVIG resistance exhibited significantly higher CRP/HDL-C ratios. The incidence of CAL was significantly higher in the IVIG-resistant group than in the IVIG-sensitive group. Collectively, these findings indicate that the CRP/HDL-C ratio can serve as a valuable biomarker for predicting the risk of both CAL formation and IVIG resistance in this patient population.