Xiaobi Huang, Sheng Zhao, Zhiyuan Liu, Yanyan Xu, Fang Deng
Background: Intravenous Immunoglobulin (IVIG) resistance prediction is a main topic of interest in Kawasaki disease (KD). In this study, we examined the value of Serum Amyloid A (SAA) for predicting IVIG resistance in KD patients.
Methods: 409 KD patients were retrospectively enrolled and divided into IVIG responsive (n=366) and IVIG resistant (n=43) groups according to the definition of IVIG resistance. Serum SAA levels prior to IVIG therapy were measured at the acute phase. Demographic, echocardiography, and laboratory data were also retrospectively analyzed.
Results: Levels of SAA, total bilirubin, C-reactive protein, neutrophils, alanine aminotransferase, aspartate aminotransferase, interleukin-6 and procalcitonin were significantly higher in the IVIG resistant group than in the IVIG responsive group (P<0.05), but the lymphocytes, platelets, serum sodium level and duration of fever before IVIG therapy were significantly lower (P<0.05). Multiple logistic regression analysis showed SAA (P=0.008), neutrophils (P<0.001), total bilirubin (P=0.001), platelets (P=0.004) and serum sodium(P=0.019) were independent predictors of IVIG resistance. The best cut-off value of SAA for IVIG resistance prediction was 252.45 mg/L, with a corresponding sensitivity of 69.8% and a specificity of 54.4%. Based on ROC curve analyses, The AUC of combined detection with these five indicators was 0.800; the sensitivity was 69.8%, and specificity was 76.2%.
Conclusions: SAA may be a candidate biomarker for predicting IVIG responsiveness to KD, Combined detection of SAA, total bilirubin, neutrophils, platelets and sodium is superior to that of any single indicator for predicting IVIG resistance in KD. Its use in clinical practice may help in treatment decisions.