The Predictive Value Of PLT,NT-pro BNP And D-dimer For Kawasaki Disease Complicated With Coronary Artery Lesions

Objective:To retrospectively analyze the clinical characteristics of children with Kawasaki disease(KD)complicated with Coronary artery lesion(CAL).The clinical data,laboratory test results,echocardiography results,and other indicators were analyzed by univariate and multivariate logistic regression analysis to explore the predictive value of PLT,NT-pro BNP and D-dimer in KD complicated with CAL.Methods:A total of 110 children who were initially diagnosed with Kawasaki disease(KD)in the Department of Cardiology of *** and *** from September 2020 to October 2022 were collected as the research objects.The data included admission number,name,age,sex,height,weight,admission time,general clinical features(fever,bulbar conjunctival hyperemia,chapped lips,strawberry tongue,cervical lymph node enlargement,acral scleroma,rash,perianal peels)and laboratory results: Leukocyte count(WBC),platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW)Mean platelet volume/lymphocyte ratio(MPVLR),hemoglobin(Hb),C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),albumin(ALB),sodium ion(Na+),Aspartate transaminase(ALT),aspartate transaminase(AST),Nterminal pro-brain natriuretic peptide(NT-pro)BNP),D-dimer,interleukin-6(IL-6)and all echocardiographic results during hospitalization,etc.According to the diagnostic grouping criteria,one group was coronary artery disease group(CAL group),and the other group was non-coronary artery disease group(NCAL group).SPASS26.0 software was used for data analysis.The indicators with statistical significance were obtained by single factor regression analysis(P < 0.05)were used as independent variables for multivariate logistic regression analysis.Finally,independent risk factors of KD combined with CAL were obtained,and Receiver operating curve(ROC)was drawn and constructed,and the Area Under the ROC Curve(AUC)and the predictive efficacy of PLT,NT-pro BNP and D-dimer were calculated.P < 0.05 was considered statistically significant.Results:1.Among the 110 KD patients,69(62.7%)were boys and 41(37.3%)were girls,with a male: female ratio of 1.68:1.The age distribution was from 3 months to 7 years,with an average age of(2.46±1.53)years.2.In CAL group,boys accounted for 75.6% and girls accounted for 24.4%.Boys accounted for 55.1%and girls for 44.9% in the NCAL group.The proportion of boys in the KD with CAL group was apparently higher than that in the NCAL group,there was a significant difference in gender between the two groups(P< 0.05).3.KD was more common in children aged 2 to 5 years,and was more common in winter and summer.In the CAL group,the peak age was < 2 years,followed by 2-5 years.The NCAL group was more common in 2-5 years old,followed by < 2 years old.There was no statistical significance in age and onset season of the two groups4.The incidence of clinical symptoms in KD children from high to low was fever(100%),bulbar conjunctival hyperemia(87.3%),strawberry tongue(74.5%),cervical non-suppurative lymph node enlargement(56.4%),chapped lips(54.5%),acral scleroma(46.4%),rash(37.3%),and perianal peeling(18.2%).Redness and swelling at BCG vaccination sites(13.6%).Febrile symptoms were present in all the children.In addition to fever,bulbar conjunctival congestion was the most common clinical symptom.5.The levels of WBC,CRP,PCT,PLT,NT-pro BNP,ALB and D-dimer in the CAL group were significantly higher than those in the NCAL group(p< 0.05).There were no significant differences in Hb,MPV,MPVLR,PDW,ESR,IL-6,ALT and AST between the two groups(p > 0.05).6.Multivariate logistic regression analysis suggested that PLT(OR=1.018,95%CI=1.003-1.033,p=0.016),NT-pro BNP(OR=1.016,95%CI=1.006-1.026,p =0.016),NT-pro BNP(OR=1.016,95%CI=1.006-1.026,p=0.002)and D-dimer(OR=2.280,95%CI=1.268-4.100,p =0.006)were independent risk factors for CAL in KD patients(p < 0.05).7.The area under the ROC curve of the combination of PLT,NT-pro BNP and D-dimer for predicting CAL was 0.866,the sensitivity of 80.5%,and a specificity of 79.7%.Conclusion:1.KD mainly occurs in winter and summer,and children aged 2-5 years have a higher incidence.There is no correlation between CAL and the age of onset.2.Boys with KD have a higher risk of CAL than girls.3.The independent risk factors of CAL in KD are PLT,D-dimer and NT-pro BNP,and the combined diagnosis of the three has higher predictive value than those of the the single use,which can be used as a potential predictor of CAL in KD.