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.
Highlights
Kawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication
Acute acalculous cholecystitis (AAC) is an inflammatory disease of the gallbladder (GB) with symptoms lasting 1 month or less, which was rarely diagnosed in the past but whose incidence is increasing because of increased awareness and improved diagnostic imaging modalities [1,2]
Of the diagnostic criteria for typical KD, changes in the peripheral extremities were significantly more frequent in the AAC group than in the non-AAC group (p = 0.021; odds ratio [OR] = 3.714; 95% confidence interval (CI): 1.272–10.847] and conjunctivitis was less frequent in the AAC group (p = 0.046; OR = 0.249; 95% CI: 0.064–0.965)
Summary
Kawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication. An association has been noted between elevated liver enzymes or an abnormal gallbladder (GB) and hepatobiliary involvement in KD. 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. Despite medical treatment, including administration of intravenous immunoglobulin (IVIG), coronary artery abnormality (CAA) is reported to develop as a complication of KD in about 5% of patients [9,10]. Rapid suspicion and accurate diagnosis of KD based on clinical manifestations, laboratory studies, and echocardiographic examination, followed by appropriate treatment, may be essential to prevent CAA [8,13]
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