Predictive value of the lactate dehydrogenase to albumin ratio for coronary artery lesions and IVIG resistance in Kawasaki disease

Early identifying coronary artery lesions (CALs), along with some children with Kawasaki disease (KD) don’t respond to intravenous immunoglobulin (IVIG), continues to be a crucial and hotly contested area of study in current medical research. This research sought to investigate the predictive significance of the lactate dehydrogenase to albumin ratio (LAR) in KD complicated with CALs and IVIG for the first time. A retrospective study was carried out on the medical files of patients diagnosed with Kawasaki disease who had been admitted to the pediatrics department at Shandong University Qilu Hospital from January 2016 through August 2023. Construct the nomogram model of KD complicated with CALs and IVIG resistance and performed internal validation. The nomogram's effectiveness was confirmed through the use of ROC curve and calibration curve. A total of 416 KD children were enrolled. LAR was significantly higher in patients with KD combined with CALs and IVIG resistance, serving as a predictive risk factor for both. The nomogram for CALs, constructed with gender, monocyte count (MON), mean platelet volume (MPV), albumin (ALB) and LAR as predictive risk factors, and the nomogram for IVIG resistance, incorporating white blood cell (WBC), MPV, ALB and LAR as predictive risk factors, both exhibited good discrimination (training/validation set area under the curves: 0.761/0.692 and 0.812/0.698) and calibration. LAR had moderate predictive value for both outcomes. Elevated level of LAR was closely associated with the occurrence of CALs and IVIG resistance. This suggests that LAR could potentially serve as an emerging predictor for CALs progression and IVIG resistance in KD.