Hepatic dysfunction secondary to Kawasaki disease: characteristics, etiology and predictive role in coronary artery abnormalities
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Coronary artery abnormalities (CAAs) are prominent during the acute Kawasaki disease (KD) episode and represent the major contributors to the long-term prognosis. Several meta-analysis and published scoring systems have identified hepatic dysfunction as an independent predictor of CAA risks. The medical records of 210 KD children were reviewed. Blood samples were collected from all subjects at 24 h pre-therapy and 48 h post-therapy, respectively. Liver function test (LFT) and inflammatory mediators were detected. Multivariate logistic regression analysis was conducted to identify the reliable biomarkers predicting whether CAAs existed or not in KD patients. 90.95% of KD patients had at least 1 abnormal LFT. Hypoalbuminemia was the most prevalent type of hepatic dysfunction, followed by elevated aspartate aminotransferase, low TP, low A/G and hyperbilirubinemia, respectively. The elevated inflammatory mediators (procalcitonin and C-reactive protein) and moderate dose of aspirin played a synthetic role in hepatic dysfunction secondary to KD. However, LFT presented no significant differences between infectious and noninfectious conditions. By a multivariate analysis, a lower albumin/globulin ratio (A/G, OR 13.50, 95% CI 3.944–46.23) served as an independent predictor of CAAs and had a sensitivity of 56.25%, and a specificity of 61.11% at a cutoff value of < 1.48. In conclusion, hepatic dysfunction is a common complication during the acute KD episode, characterized by elevated serum liver enzymes, hypoalbuminemia and hyperbilirubinemia. Systemic inflammation and aspirin, rather than infectious agents, are both the major contributors of hepatic dysfunction secondary to KD. A lower A/G serves as an independent predictor of CAAs.
KeywordsCoronary artery abnormalities Hepatic dysfunction Hypoalbuminemia Kawasaki disease Multivariate analysis
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GM, HHL and WXC. The first draft of the manuscript was written by GM, HHL and WXC and all authors commented on previous versions of the manuscript. All authors contributed to the data interpretation and manuscript revision. All authors read and approved the final manuscript.
This study was supported by the New Technology Project of the First Affiliated Hospital, Anhui Medical University (2014-01).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The research was in compliance with the Declaration of Helsinki. Approval for this research was acquired from the Medical Ethic Committee of the First Affiliated Hospital of Anhui Medical University (Code number; LLSC/20150009).
Informed consent was obtained from all individual participants included in the study.
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