Age-specific Association of Serum Albumin with Immunoglobulin Resistance and Coronary Artery Involvement in Kawasaki Disease.

Lower albumin levels are a potential risk factor for intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in patients with Kawasaki disease (KD). No age-specific studies have been conducted on the association between lower albumin levels and these outcomes. We analyzed 18,336 patients who developed KD nationwide in Japan from 2011 to 2012. These patients were divided into three age groups: <1 year, 1–4 years, and 5–9 years. Multivariable logistic regression analyses were performed to evaluate the association between serum albumin decrease and (1) IVIG resistance and (2) CALs among these age groups. Each 0.1 g/dL albumin decrease was strongly associated with IVIG resistance in the patients aged < 1 year (adjusted odds ratios [95% confidence interval]: 1.96 [1.60–2.40]). Patients aged 1–4 years demonstrated a moderate association (1.47 [1.31–1.65]), and no association was observed in those aged 5–9 years (1.24 [0.95–1.62]). Similarly, lower albumin levels had an age-specific association with CALs (1.72 [1.11–2.70] for < 1 year, 1.67 [1.19–2.33] for 1–4 years, and 0.61 [0.33–1.10] for 5–9 years). Lower albumin levels were significantly associated with an increased risk of IVIG resistance and CALs, with the association strength varying by age. When assessing risk for treatment failure and coronary complications, serum albumin levels may be stratified by age.