Interleukin‐17A, Interleukin‐8, and Platelet Count Are Associated With Baseline Coronary Artery Lesions in Children With Kawasaki Disease: A Retrospective Exploratory Cohort Study
Cuijie Gong, Yahui Lin, Yanmei Lang, Xinfeng Liu, Dandan Li, Sha Wang, Pan LiABSTRACT
Background
Kawasaki disease (KD) is an acute childhood vasculitis in which coronary artery lesions (CALs) determine long‐term cardiovascular risk. We evaluated a focused pre‐IVIG biomarker profile in relation to baseline Z‐score‐defined coronary involvement.
Objective
To examine whether interleukin‐17A (IL‐17A), interleukin‐8 (IL‐8), and platelet count (PLT) were associated with baseline CAL and to assess the robustness and internal discrimination of this exploratory profile.
Methods
This single‐center retrospective exploratory cohort study screened 242 children with suspected KD treated in 2023. After 43 exclusions, 199 children were analyzed (non‐CAL, n = 166; CAL, n = 33). CAL was defined using pretreatment segment‐level coronary Z‐scores recorded in the institutional echocardiographic database. To limit model complexity, the primary Firth‐penalized logistic model was restricted to three predictors (PLT, IL‐8, and IL‐17A; 11 events per predictor). A nine‐covariate clinically informed model and illness‐timing/incomplete‐KD models were treated as sensitivity analyses. Internal validation used 1000‐resample bootstrap optimism correction and 100 repeated stratified fivefold cross‐validation with complete refitting.
Results
Compared with the non‐CAL group, children with CAL had higher PLT, IL‐6, IL‐8, and IL‐17A and lower hematocrit (HCT), among other group‐level differences. In the primary Firth model, PLT (OR, 3.081 per 100 × 10 9 /L; 95% CI, 1.582–6.002), IL‐8 (OR, 1.167 per 10 pg/mL; 95% CI, 1.076–1.266), and IL‐17A (OR, 6.555 per 10 pg/mL; 95% CI, 3.054–14.071) were associated with baseline CAL. The apparent AUC was 0.975, the optimism‐corrected AUC was 0.972, and the repeated‐cross‐validation mean AUC was 0.966 (SD, 0.006).
Conclusions
Higher pre‐IVIG IL‐17A, IL‐8, and PLT were associated with baseline Z‐score‐defined CAL. These internally validated but single‐center observational findings neither establish mechanism nor justify biomarker‐guided imaging or treatment. Prospective multicenter external validation is required before clinical use.