Cui Yaru, Zhang Linling, Liu Xiaoliang, Liu Lei, Zhou Kaiyu, Hua Yimin, Shao Shuran, Wang Chuan
Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
West China Medical School of Sichuan University, 610041 Chengdu, Sichuan, China.
Rev Cardiovasc Med. 2024 Nov 22;25(11):421. doi: 10.31083/j.rcm2511421. eCollection 2024 Nov.
Predicting resistance to intravenous immunoglobulin (IVIG) in the treatment of Kawasaki disease (KD) remains a focus of research. Fibrinogen and albumin in systemic inflammation play an important role. This study aims to investigate the predictive value of fibrinogen to albumin ratio (FAR) for initial IVIG resistance in patients with KD.
The study prospectively recruited 962 patients with KD between July 2015 and June 2022. The serum characteristics of the two groups were compared by comparing fibrinogen and albumin, as well as other laboratory and clinical data between the IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression was used to explore the relationship between FAR and IVIG resistance. Receiver operating characteristic (ROC) curves were used to determine the effectiveness of FAR in predicting initial IVIG resistance.
Our results demonstrated that IVIG-resistant patients had significantly higher fibrinogen levels (603.35 ± 99.00 mg/L), FAR (17.30 ± 3.31), and lower albumin (35.47 ± 5.24 g/L) compared to IVIG-responsive patients (fibrinogen 572.35 ± 145.75 mg/L; FAR 15.08 ± 4.32; albumin 38.52 ± 4.55 g/L). 15.20 was the best cut-off value of FAR for predicting initial IVIG resistance. The sensitivity was 72.5%, the specificity was 51.3%, the positive predictive value was 91.8%, and the negative predictive value was 20.0%. Multivariate logistic regression analysis, found that FAR was an independent predictor of initial IVIG resistance in KD children.
The FAR was an independent risk factor for initial IVIG resistance, its predictive power for initial IVIG resistance exceeded that of albumin and fibrinogen alone. FAR may not be suitable as a single marker but might serve as a complementary laboratory marker to accurately predict initial IVIG resistance in KD.
预测川崎病（KD）治疗中对静脉注射免疫球蛋白（IVIG）的耐药性仍是研究重点。纤维蛋白原和白蛋白在全身炎症中起重要作用。本研究旨在探讨纤维蛋白原与白蛋白比值（FAR）对KD患者初始IVIG耐药性的预测价值。
本研究前瞻性纳入了2015年7月至2022年6月期间的962例KD患者。通过比较纤维蛋白原和白蛋白以及IVIG敏感组和IVIG耐药组之间的其他实验室和临床数据，比较两组的血清特征。采用多因素逻辑回归分析探讨FAR与IVIG耐药性之间的关系。采用受试者工作特征（ROC）曲线确定FAR预测初始IVIG耐药性的有效性。
我们的结果表明，与IVIG敏感患者（纤维蛋白原572.35±145.75mg/L；FAR 15.08±4.32；白蛋白38.52±4.55g/L）相比，IVIG耐药患者的纤维蛋白原水平（603.35±99.00mg/L）、FAR（17.30±3.31）显著更高，白蛋白水平（35.47±5.24g/L）更低。15.20是FAR预测初始IVIG耐药性的最佳截断值。敏感性为72.5%，特异性为51.3%，阳性预测值为91.8%，阴性预测值为20.0%。多因素逻辑回归分析发现，FAR是KD患儿初始IVIG耐药性的独立预测因素。
FAR是初始IVIG耐药性的独立危险因素，其对初始IVIG耐药性的预测能力超过单独的白蛋白和纤维蛋白原。FAR可能不适合作为单一标志物，但可作为补充实验室标志物，以准确预测KD患者的初始IVIG耐药性。
