Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children

BMC Pediatrics

Hye Ran Yang³  Jung Yun Choi³  Eun Young Choi¹  Ji Young Kim²  Dae Yong Yi¹ 

[1] Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea;Department of Radiology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea;Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

关键词: Child;    Coronary artery disease;    Acalculous cholecystitis;    Ultrasonography;    Kawasaki disease;   

Others  :  1139001
DOI  :  10.1186/1471-2431-14-51

 received in 2013-10-09, accepted in 2014-02-13,  发布年份 2014

【 摘 要 】

Background

Kawasaki 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.

Methods

From 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.

Results

Among 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.

Conclusion

For 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.

【 授权许可】

   
2014 Yi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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