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Evaluating the added predictive ability of MMP-9 in serum for Kawasaki disease with coronary artery lesions
  1. Lixia Wang1,
  2. Yinan Yang2,
  3. Quanmiao Cui1,
  4. Ya Cui1,
  5. Qiaoe Li1,
  6. Xinyao Che1,
  7. Cong Wang1,
  8. Peiqin Quan1,
  9. Xiaobin Hu1
  1. 1 Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
  2. 2 Department of Pediatrics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
  1. Correspondence to Professor Xiaobin Hu, Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China; huxiaobin{at}


To investigate the predictive ability of serum matrix metalloproteinase-9 (MMP-9) in the acute phase of Kawasaki disease (KD) with coronary artery lesions (CALs). Patients with KD hospitalized in Lanzhou University Second Hospital, Northwest China, from November 2015 to January 2018 were retrospectively reviewed, and clinical trial indicators and peripheral blood specimens were collected before intravenous immunoglobulin therapy treatment. The independent risk factors were determined using multivariate regression analysis. The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to quantitatively evaluate the ability of MMP-9 to improve the efficiency of predicting KD with CALs. The white cell, neutrophil percentage, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were higher in patients with higher MMP-9, and the monocyte percentage was higher in patients with lower MMP-9. Logistic regression analysis revealed that long-term fever; elevated CRP, ESR, platelets (PLT), and MMP-9; and low albumin (ALB) levels were independent predictors of KD with CALs. A predictive model of KD with CALs using fever duration, CRP, ESR, PLT, and ALB showed significantly improved predictive ability when MMP-9 was added to the model (the area under the curve increased by 0.02; no change in sensitivity; specificity increased from 81.48% to 87.04%; NRI value: 13.46%; IDI value: 5.00%, p<0.05). Adding MMP-9 to traditional risk factors may improve prediction of CALs, the overall predictive ability of model 2 was increased by 5%.

  • biological markers
  • coronary artery disease
  • comorbidity
  • enzyme-linked immunosorbent assay
  • extracellular matrix proteins

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  • LW and YY contributed equally.

  • Contributors XH and LW originally conceived the study. LW and YY conducted the experiment. QC and YC contributed to data acquisition. LW, QC, YC, QL, XC, CW, and PQ contributed to data analysis and statistical analyses. LW drafted the manuscript. All authors read and approved the final manuscript.

  • Funding This study received funding from the government, item number: 18JR3RA323 from the Natural Science Foundation of Gansu Province.

  • Disclaimer The institutes provided financial support but did not influence the way in which we collected, analyzed, or interpreted the data or wrote this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Ethics approval This study is a retrospective study, which only collected the patient’s clinical data and laboratory data, and all patient information remained confidential. The Ethics Committee of Lanzhou University Second Hospital (No 2018A-059) waived the requirement for informed consent. In addition, the blood sample used in this study is the remaining blood sample from other studies. The informed consent signed by the patient’s parent or guardian has clearly stated that the blood sample can be used for subsequent clinical research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from Lanzhou University Second Hospital. Data are available from the authors upon reasonable request and with permission of Lanzhou University Second Hospital. Email: