Lactate dehydrogenase-to-albumin ratio as a predictor of coronary artery lesions in Kawasaki disease.

Background: The lactate dehydrogenase-to-albumin ratio (LAR), a novel marker reflecting systemic inflammation and nutritional status, was investigated for its association with coronary artery lesions (CALs) in Kawasaki disease (KD). Methods: A total of 231 pediatric patients with KD were stratified into the CAL group (n=35) and the non-CAL group (n=196). The CAL was defined based on the adjusted Z-score ≥2.0 of the coronary artery inner diameter according to body surface area. Demographic data and pre-treatment laboratory parameters were collected. Univariate analysis was used to screen for potential predictive factors, and multivariate logistic regression was used to analyze the influencing factors of KD complicated with CAL. The predictive performance was evaluated using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) was calculated. Results: Univariate analysis revealed that the CAL group exhibited younger age, and significantly elevated levels of LAR and lactate dehydrogenase and higher proportion of incomplete KD compared to the non-CAL group (all P<0.05). Multivariate analysis confirmed LAR [odds ratio (OR) =1.152] and incomplete KD (OR =4.268) were independent predictive factors of CAL in KD. In the subgroup analysis of complete KD, LAR was remained significantly associated with CAL (P<0.05). ROC curve analysis identified the combined AUC of LAR and incomplete KD was 0.719 [95% confidence interval (CI): 0.629-0.810] and an optimal LAR cutoff of 6.97 (AUC =0.671, sensitivity =80.00%, specificity =53.10%). For complete KD, the optimal LAR cutoff for predicting CAL was 7.00, with an AUC of 0.662 (95% CI: 0.557-0.768). Conclusions: LAR was an independent influencing factor for KD complicated with CAL. LAR could be utilized as an auxiliary diagnostic biomarker for CAL in KD, particularly in complete KD cases, offering a reference for precise KD management.