Association between Alanine Aminotransferase/Aspartate Aminotransferase Ratio (AST/ALT Ratio) and Coronary Artery Injury in Children with Kawasaki Disease

Abstract

Objective. To investigate the association between the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT ratio, AAR) and intravenous immunoglobulin (IVIG) resistance, coronary artery lesions (CAL), and coronary artery aneurysms (CAA) in children with Kawasaki disease (KD). Design. We retrospectively studied 2678 children with KD and divided them into two groups: a low-AAR group and a high-AAR group with a median AAR of 1.13 as the cut-off point. The differences in laboratory data, clinical manifestations, and coronary artery damage rates were compared between the two groups. Results. The incidence of CAL was higher in the low-AAR group than in the high-AAR group at 2 and 3-4 weeks after illness onset (p<0.001, respectively). The IVIG resistance rate was significantly higher in the low-AAR group than in the high-AAR group (29.94% vs 21.71%, p<0.001). The levels of C-reactive protein, erythrocyte sedimentation rate, white blood cell count, bilirubin, fibrinogen, thrombin time, D-dimer, and brain natriuretic peptide were also significantly higher in the low-AAR group compared with the high-AAR group. The levels of albumin and IgG were significantly lower in the low-AAR group compared with those of the high-AAR group. The proportion of typical KD cases in the low-AAR group was significantly higher than that in the high-AAR group. Low-AAR correlated with the risk of coronary artery damage and IVIG resistance. Conclusion. Children with KD who had low-AAR value were more likely to develop coronary artery damage and IVIG resistance. Low AAR is a risk factor for CAL, CAA, and IVIG resistance in KD.

The Association of Aspartate Aminotransferase/Alanine Aminotransferase Ratio with Diabetic Nephropathy in Patients with Type 2 Diabetes

“…Wang et al have confirmed the significant effect of the AST/ALT, as well as the CRP level. 8 Therefore, it is reasonable to guess that the increase of AST/ALT increased DN through inflammation cytokines. AST/ALT is often used to evaluate liver function and reflect the severity of liver disease.…”

“… 7 AST/ALT is correlated with oxidative stress and systemic inflammation. 8 Although it was originally proposed as a feature of viral hepatitis, such a ratio seems to serve as a practical biomarker for other diseases. It has been reported that AST/ALT is correlated with chronic kidney disease (CKD) and metabolic syndrome (MetS).…”

High aspartate aminotransferase to alanine aminotransferase ratio on admission as risk factor for poor prognosis in COVID-19 patients

“…Additionally, the AST/ALT ratio was found to be a risk factor for death in both groups of COVID-19 patients with normal or abnormal AST levels. Besides that, the AST/ALT ratio, for unclear reasons, has some extrahepatic implications, including predicting poor outcomes of pancreatic cancer patients 33 and heart injury in Kawasaki disease 34 . Therefore, the role of the AST/ALT ratio in COVID-19 remains to be further analyzed.…”

Paediatric multisystem inflammatory syndrome associated with COVID-19: filling the gap between myocarditis and Kawasaki?

“…As in the adult, it can be hypothesized that SARS-CoV-2 infection could induce an inappropriate immune response, causing an inflammatory reaction leading to vasculitis [ 11 , 23 , 24 ]. Another possibility is that inflammatory diseases like Kawasaki and myocarditis could directly result in an endothelial lesion provoked by a specific virus [ 1 , 25 , 26 ]. Finally, these types of inflammatory diseases could depend on the external viral pressure.…”