The correlation and auxiliary diagnostic value of gut microbiota and serological indicators with Kawasaki disease complicated by coronary artery lesions.
Yang S, Ding Y, et al. • Frontiers in cellular and infection microbiology • 2026
The combined detection of gut microbiota Ace index, pro-inflammatory factors (CRP, TNF-α, IFN-γ, IL-6, IL-4), CD4+/CD8+ ratio, and IL-10 demonstrated good efficacy (AUC 0.911) for diagnosing Kawasaki disease complicated by coronary artery lesions and might provide clinical reference for early identification of high-risk children.
Key Findings
Results
Children with Kawasaki disease complicated by coronary artery lesions (CAL) had significantly elevated serum inflammatory markers compared to those without CAL.
The CAL group (n=57) showed significantly higher levels of CRP, TNF-α, IFN-γ, IL-2, IL-4, IL-6, and IL-10 compared to the control group (n=102) (P < 0.05)
The CD4+/CD8+ ratio was also significantly elevated in the CAL group (P < 0.05)
Both pro-inflammatory cytokines and the anti-inflammatory cytokine IL-10 were elevated in the CAL group
This was a retrospective study of KD children diagnosed and treated from January 2022 to December 2023
Results
Gut microbiota species richness, as measured by the Ace index, was significantly decreased in KD children with coronary artery lesions compared to those without.
The Ace index, an α-diversity indicator reflecting gut microbiota species richness, was significantly decreased in the CAL group compared to the control group (P < 0.05)
The Shannon index was also measured as a gut microbiota diversity indicator
The decrease in Ace index suggests reduced gut microbial diversity in KD children who develop coronary artery lesions
Results
The gut microbiota Ace index was negatively correlated with all measured serum inflammatory markers and the CD4+/CD8+ ratio.
Pearson correlation analysis showed the Ace index was negatively correlated with CRP, TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-10, and CD4+/CD8+ ratio (P < 0.05)
This suggests that lower gut microbiota species richness is associated with higher systemic inflammation in KD children
The negative correlation applied to both pro-inflammatory (IL-2, IL-4, IL-6, TNF-α, IFN-γ) and anti-inflammatory (IL-10) cytokines
Results
Multivariate logistic regression identified the Ace index, multiple pro-inflammatory factors, CD4+/CD8+ ratio, and IL-10 as independent factors associated with coronary artery lesions in Kawasaki disease.
Independent factors included: Ace index, CRP, TNF-α, IFN-γ, IL-6, IL-4, CD4+/CD8+ ratio, and IL-10 (all P < 0.05)
All variables had variance inflation factor (VIF) < 5, indicating no significant multicollinearity
Both pro-inflammatory cytokines and the anti-inflammatory cytokine IL-10 were independently associated with CAL
Results
Combined detection of gut microbiota and serological indicators achieved an AUC of 0.911 for diagnosing KD complicated by coronary artery lesions, outperforming any single indicator.
The AUC for combined detection was 0.911 (95% CI: 0.860–0.962)
Combined detection specificity was 81.37% and sensitivity was 87.72%
The combined model's diagnostic efficacy was superior to any single indicator alone
ROC curve analysis was used to evaluate diagnostic performance of each indicator and their combination
What This Means
This research suggests that children with Kawasaki disease (KD) who develop coronary artery complications have distinct biological signatures compared to those who do not. Specifically, children with coronary artery lesions showed higher levels of multiple inflammatory proteins in their blood (including CRP, TNF-α, several interleukins, and an elevated CD4+/CD8+ immune cell ratio) alongside reduced diversity of bacteria in their gut. The study also found that lower gut bacterial diversity was consistently linked to higher levels of inflammation markers, suggesting the gut microbiome and immune system may be interconnected in this condition.
The study further found that when these gut microbiota and blood markers were combined into a single diagnostic model, they could identify children at high risk for coronary artery lesions with strong accuracy — correctly identifying about 88% of affected children (sensitivity) while correctly ruling out the condition in about 81% of unaffected children (specificity), with an overall diagnostic performance score (AUC) of 0.911 out of 1.0. This combined approach outperformed any single marker used alone.
This research suggests that monitoring gut microbiota diversity alongside standard blood inflammatory markers could help clinicians identify KD children at higher risk for developing coronary artery complications earlier in the disease course. Because this was a retrospective study from a single hospital involving 159 children, further prospective and multicenter studies would be needed to validate these findings before clinical application.
Yang S, Ding Y, Liu F, Wang S, Chen J, Wu Y. (2026). The correlation and auxiliary diagnostic value of gut microbiota and serological indicators with Kawasaki disease complicated by coronary artery lesions.. Frontiers in cellular and infection microbiology. https://doi.org/10.3389/fcimb.2026.1865661