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

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. 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. 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). 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.