Abstract Objective To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD. Methods The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD. Results Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05). Conclusions Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.
HU Hui-Min,CHEN Xiao-Zheng,ZHANG Yong-Lan et al. Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease[J]. CJCP, 2022, 24(6): 681-686.
HU Hui-Min,CHEN Xiao-Zheng,ZHANG Yong-Lan et al. Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease[J]. CJCP, 2022, 24(6): 681-686.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
Terman A, Dalen H, Eaton JW, et al. Aging of cardiac myocytes in culture: oxidative stress, lipofuscin accumulation, and mitochondrial turnover[J]. Ann N Y Acad Sci, 2004, 1019: 70-77. PMID: 15246997. DOI: 10.1196/annals.1297.015.
Jang M, Oh MS, Oh SC, et al. Distribution of diseases causing liver function test abnormality in children and natural recovery time of the abnormal liver function[J]. J Korean Med Sci, 2016, 31(11): 1784-1789. PMID: 27709857. PMCID: PMC5056211. DOI: 10.3346/jkms.2016.31.11.1784.
Makino N, Nakamura Y, Yashiro M, et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey[J]. J Epidemiol, 2015, 25(3): 239-245. PMID: 25716368. PMCID: PMC4341001. DOI: 10.2188/jea.JE20140089.
Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
Han RK, Silverman ED, Newman A, et al. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease[J]. Arch Pediatr Adolesc Med, 2000, 154(7): 694-699. PMID: 10891021. DOI: 10.1001/archpedi.154.7.694.
Sato S, Kawashima H, Kashiwagi Y, et al. Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients[J]. Int J Rheum Dis, 2013, 16(2): 168-172. PMID: 23773640. DOI: 10.1111/1756-185X.12082.
Honkanen VE, McCrindle BW, Laxer RM, et al. Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease[J]. Pediatr Cardiol, 2003, 24(2): 122-126. PMID: 12457252. DOI: 10.1007/s00246-002-0063-1.
Patel RM, Shulman ST. Kawasaki disease: a comprehensive review of treatment options[J]. J Clin Pharm Ther, 2015, 40(6): 620-625. PMID: 26547265. DOI: 10.1111/jcpt.12334.
Kim MK, Song MS, Kim GB. Factors predicting resistance to intravenous immunoglobulin treatment and coronary artery lesion in patients with Kawasaki disease: analysis of the Korean nationwide multicenter survey from 2012 to 2014[J]. Korean Circ J, 2018, 48(1): 71-79. PMID: 29171205. PMCID: PMC5764872. DOI: 10.4070/kcj.2017.0136.
Ae R, Abrams JY, Maddox RA, et al. Platelet count variation and risk for coronary artery abnormalities in Kawasaki disease[J]. Pediatr Infect Dis J, 2020, 39(3): 197-203. PMID: 31851145. DOI: 10.1097/INF.0000000000002563.
Nakamura N, Muto T, Masuda Y, et al. Procalcitonin as a biomarker of unresponsiveness to intravenous immunoglobulin for Kawasaki disease[J]. Pediatr Infect Dis J, 2020, 39(9): 857-861. PMID: 32433223. DOI: 10.1097/INF.0000000000002716.
Clark DE, Denby KJ, Kaufman LM, et al. Predictors of intravenous immunoglobulin nonresponse and racial disparities in Kawasaki disease[J]. Pediatr Infect Dis J, 2018, 37(12): 1227-1234. PMID: 29570178. DOI: 10.1097/INF.0000000000002019.
Shaanxi Province Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial
People's Hospital, Children's Hospital of Shanghai Jiao Tong University, Beijing Children's Hospital of Capital Medical
University, Shengjing Hospital of China Medical University, Affiliated Hospital of Yan'an University, Expert Committee
of Advanced Training for Pediatrician, China Maternal and Children's Health Association, General Pediatric Group of
Pediatrician Branch of Chinese Medical Doctor Association, Pediatric International Exchange and Cooperation Center,
Shanghai Cooperation Organization Hospital Cooperation Alliance, Editorial Board of Chinese Journal of
Contemporary Pediatrics. Pediatric expert consensus on the application of aspirin in Kawasaki disease[J]. CJCP, 2022, 24(6): 597-603.
