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AST-to-ALT ratio and coronary artery lesions among patients with Kawasaki disease

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Abstract

Background

The aim of this study was to explore the associations between the aspartate aminotransferase-to-alanine aminotransferase ratio (AST/ALT) and coronary artery lesions (CALs) among patients with Kawasaki disease (KD).

Methods

Medical records of KD patients presenting to a single center between January 2019 and December 2020 were retrospectively collected and analyzed. Univariate, multivariable-adjusted analyses, subgroup analyses, restricted cubic spline test, and fitted curves were used to evaluate the associations between AST/ALT and CALs.

Results

A total of 831 patients were enrolled, of which 201 (24.2%) had CALs on admission and 21 (2.5%) developed CALs de novo after intravenous immunoglobulin (IVIG). Multivariable-adjusted analyses models revealed that a lower AST/ALT was associated with an increased risk of CALs on admission when AST/ALT was a continuous variable (P = 0.007) and when it was a categorical variable (P for trend = 0.004). Each unit increase in AST/ALT was associated with a 22% lower risk of CALs on admission (odds ratio = 0.78, 95% confidence interval 0.65–0.94). A negative linear relationship was noted between AST/ALT and the risk of CALs on admission in both observed and fitted models. However, such associations were not observed in AST/ALT and CALs de novo after IVIG. None of the variables significantly modified the association between AST/ALT and CALs on admission and CALs de novo after IVIG (P > 0.05).

Conclusion

Our findings suggested that AST/ALT was a risk factor of CALs, but was not associated with progressive CALs.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was financially supported by the National Natural Science Foundation of China (Nos. 81870365, 81700439, and 81801559), Gusu Health Personnel Training Project (Nos. GSWS2019048 and 2020054), Suzhou Science and Technology Development Plan Project (Nos. SYS2019084 and SS202066), and Jiangsu Province Key Medical Young Talents (No. QNRC 2016765).

Author information

Authors and Affiliations

  1. Department of Cardiology, Children’s Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China

    Lei Cao, Yun-Jia Tang, Miao Gang, Wei-Guo Qian, Qiu-Qin Xu & Hai-Tao Lv

  2. Department of Pharmacy, Children’s Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, China

    Jin Ma

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  1. Lei Cao
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Contributions

CL and TYJ contributed equally to this study as first co-authors. CL contributed to investigation, methodology and writing original draft. TYJ contributed to conceptualization, data curation, funding acquisition, reviewing, and editing. GM contributed to investigation and methodology. QWG, MJ, and XQQ contributed to investigation, and project administration. LHT contributed to conceptualization, funding acquisition and supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hai-Tao Lv.

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Ethical approval

The Institutional Review Board of Children’s Hospital of Soochow University approved this study (No. 2021CS086).

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflict of interest to declare.

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Supplementary Information

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12519_2021_479_MOESM1_ESM.tif

Supplementary Fig. 1 Receiver-operator characteristic curves for the prediction of CALs on admission. The baseline predictors are age, sex, CRP, albumin, total bilirubin, delayed IVIG treatment after the 10th day, and IKD. AST aspartate aminotransferase, ALT alanine aminotransferase, CALs coronary artery lesions, IKD incomplete Kawasaki disease, IVIG intravenous immunoglobulin, CRP C-reactive protein

12519_2021_479_MOESM2_ESM.tif

Supplementary Fig. 2 Stratified analyses by possible modifications for the association between AST/ALT and CALs on admission. Adjusted for: age, sex, CRP, albumin, total bilirubin, delayed IVIG treatment after the 10th day, and IKD. In each case, the model is not adjusted for the stratification variable. A total of 824 patients were enrolled in the analysis. AST aspartate aminotransferase, ALT alanine aminotransferase, CALs coronary artery lesions, IKD incomplete Kawasaki disease, IVIG intravenous immunoglobulin, CRP C-reactive protein, CI confidence interval, OR odds ratio

12519_2021_479_MOESM3_ESM.docx

Supplementary Fig. 3 Stratified analyses by possible modifications for the association between AST/ALT and CALs de novo after IVIG. Adjusted for: age, sex, CRP, albumin, total bilirubin, delayed IVIG treatment after the 10th day, and IKD. In each case, the model is not adjusted for the stratification variable. A total of 794 patients were enrolled in the analysis. AST aspartate aminotransferase, ALT alanine aminotransferase, CALs coronary artery lesions, IKD incomplete Kawasaki disease, IVIG intravenous immunoglobulin, CRP C-reactive protein, CI confidence interval, OR odds ratio

Supplementary file4 (DOCX 16 kb)

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Cao, L., Tang, YJ., Gang, M. et al. AST-to-ALT ratio and coronary artery lesions among patients with Kawasaki disease. World J Pediatr 17, 659–668 (2021). https://doi.org/10.1007/s12519-021-00479-0

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  • DOI: https://doi.org/10.1007/s12519-021-00479-0

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