Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

Abstract

BackgroundKawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication. In some patients, an association has been noted between elevated liver enzymes or an abnormal gallbladder (GB) and hepatobiliary involvement in KD. In this study, we aimed to evaluate clinical, laboratory, and ultrasonographic (USG) risk factors of hepatobiliary involvement for the intravenous immunoglobulin (IVIG) resistance and the development of CAA in children with KD.MethodsFrom March 2004 through January 2013, clinical features, laboratory data, echocardiographic findings, and USG findings were retrospectively reviewed regarding the response to IVIG treatment and coronary artery complications in 67 children with KD. Acute acalculous cholecystitis (AAC) was diagnosed based on USG criteria.ResultsAmong all factors, only the prothrombin time international normalized ratio was significantly different between the IVIG-response and IVIG-resistance groups (p = 0.024). CAA was statistically more frequent in the AAC group (n = 24) than in the non-AAC group (n = 43) (23.3% vs. 58.3%, p = 0.019). Among the laboratory factors, segmented neutrophil percentage, total bilirubin level, and C-reactive protein were significant in children with CAA (p = 0.014, p = 0.009, and p = 0.010). Abnormal GB findings on USG were significantly more frequent in children with CAA than in those without CAA (p = 0.007; OR = 4.620; 95% confidence interval [CI]: 1.574–13.558). GB distension on USG was the only significant risk factor for CAA (p = 0.001; OR = 7.288; 95% CI: 2.243–23.681) by using multiple logistic regression analysis.ConclusionFor children in the acute phase of KD, USG findings of the GB, especially GB distension, may be an important risk factor for CAA as a complication.

Hyponatremia May Reflect Severe Inflammation in Children with Kawasaki Disease

“…Our study is the first study which showed that hypona tremia was an independent risk factor for the development of CALs in KD using multivariate analyses and it was also closely associated with other well known inflammatory markers of KD such as WBC count, ESR, and serum albumin level. Although WBC count, CRP, low serum albumin levels, or elevated serum ALT were reported to be associated with the development of CALs in KD 13,14) , these biomarkers were not statistically significant between children with KD and those without KD in our study. Although previous studies exhibited that increased CRP and total bilirubin on admission were indicated as signifi cant predictors for IVIG resistance and serum albumin levels before IVIG treatment were also suggested to be a useful predictor of IVIG resistance in patients with KD 15,16) , we did not find any significant difference between the two groups.…”

A New Era in Diagnostic Ultrasound, Superb Microvascular Imaging: Preliminary Results in Pediatric Hepato-Gastrointestinal Disorders

“…Although gastrointestinal symptoms are not a major part of the diagnostic criteria for KD, many patients present with abdominal complaints and hepatobiliary involvement with elevated liver enzymes. 3,4 Thus, we usually evaluate KD patients using cardiac and abdominal ultrasound.…”

Kawasaki disease in children: Epidemiology, clinical symptoms and diagnostics of 231 cases in 10 years

“…Parameters such as WBC, PLT, Hb, CRP and erythrocyte sedimentation rate (ESR) have been routinely used in the diagnosis of KD and have become essential indicators for observing the dynamic changes in the disease, despite their non-specificity, due to the wide-spread abnormalities in these parameters in the majority of patients with KD (24)(25)(26). Increases in CRP and ESR in the acute phase have been identified as diagnostic indicators for both typical and atypical KD (27).…”