The correlation and auxiliary diagnostic value of gut microbiota and serological indicators with Kawasaki disease complicated by coronary artery lesions.

OBJECTIVE: To compare the differences in gut microbiota diversity and serological parameters between children with Kawasaki disease (KD) complicated by coronary artery lesions (CAL) and those without CAL, and their association and auxiliary diagnostic value. METHODS: A retrospective study was conducted on 57 KD children with CAL (CAL group) and 102 KD children without CAL (control group) diagnosed and treated in our hospital from January 2022 to December 2023. The gut microbiota diversity (Ace index, Shannon index), serum inflammatory markers and CD4+/CD8+ were compared between the two groups. Pearson correlation analysis was used to explore the association between gut microbiota and serological parameters. Logistic regression analysis was employed to identify independent influencing factors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the indicators. RESULTS: Compared with the control group, the levels of serum CRP, TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-10, and CD4+/CD8+ ratio in the CAL group were significantly elevated, while the Ace index (an α-diversity indicator reflecting gut microbiota species richness) was significantly decreased (P < 0.05). Pearson correlation analysis showed that the Ace index was negatively correlated with serum CRP, TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-10, and CD4+/CD8+ ratio (P < 0.05). Multivariate Logistic regression analysis (with variance inflation factor VIF<5 for all variables, indicating no significant multicollinearity) demonstrated that the Ace index, pro-inflammatory factors (CRP, TNF-α, IFN-γ, IL-6, IL-4), CD4+/CD8+ ratio and the anti-inflammatory cytokine IL-10 were independently associated with CAL (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) for the combined detection was 0.911 (95% CI: 0.860-0.962), with a specificity of 81.37% and a sensitivity of 87.72%, and the efficacy was superior to any single indicator. CONCLUSION: The Ace index, pro-inflammatory factors (CRP, TNF-α, IFN-γ, IL-6, IL-4), and CD4+/CD8+ ratio and IL-10 were independently associated with CAL. The combined detection of the above indicators demonstrated good efficacy for KD complicated by CAL and might provide clinical reference for early identification of high-risk children.