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

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.