Implications of hepatic dysfunction in Kawasaki disease: Time‐related changes in aspartate aminotransferase, alanine aminotransferase, total bilirubin, and C‐reactive protein levels

Tomita, Yoshihiro; Fukaya, Takashi; Yamaura, Yasuko; Tsujiguchi, Rie; Muratani, Haruko; Shimaya, Maki

doi:10.1002/ped4.12112

Cited by 12 publications

(11 citation statements)

References 41 publications

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“…In this study, not only FC levels but also T-Bil, AST, and ALT level were associated with unresponsiveness to IVIG. Previous studies have shown that these values were higher in non-responders than in responders [20,21,22]. It is remarkable that all these factors have also been incorporated into the existing refractory prediction scores, such as Osaka, Kurume, and Gumma scores [7,8,9].…”

Section: Discussionmentioning

confidence: 99%

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Muto¹,

Nakamura²,

Masuda³

et al. 2020

Preprint

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Background: Carnitine plays an essential role in transfer of long-chain fatty acids to mitochondria for subsequent β-oxidation. No studies to date have characterized carnitine in children with KD. The objective of this study is to investigate the characteristics of serum free carnitine (FC) in hospitalized pediatric patients with Kawasaki disease (KD). Methods: In total, 45 patients with KD measured the levels of serum FC from October 2018 to December 2019 were analyzed retrospectively. We analyzed the clinical and laboratory parameters just before the Intravenous immunoglobulin (IVIG) including serum levels of serum FC with respect to the IVIG response. We also analyzed the relationship between serum FC and liver deviation enzymes or the duration of fever at diagnosis. Results: The median age was 33 months. IVIG was effective in 33 children (responders) and was ineffective in 12 (non-responders). The serum FC levels were higher in non-responders than in responders [(35.3 mmol/L (range, 26.8-118.4 mmol/L) vs. 31.4 mmol/L (range, 20.9-81.2 mmol/L), p value = 0.0496]. The FC levels before intravenous immunoglobulin (IVIG) in four-fifths of responders were below the normal range. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and FC were higher in non-responders than in responders. There were no different in patient characteristics and laboratory data according to fever duration at diagnosis. There was a correlation between FC and AST (R2=0.364, P=0.0015) and between FC and ALT (R2=0.423, P<0.001) levels. Conclusion: FC levels were upregulated in patients with KD who were refractory to IVIG. Additionally, FC levels in children with KD correlated with AST and ALT levels. The pathogenesis resulting in the elevation of FC levels remains elusive. Further studies are necessary to understand more precisely carnitine properties in patients with KD.

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Section: Discussionmentioning

confidence: 99%

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Muto¹,

Nakamura²,

Masuda³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In this study, not only FC levels but also T-Bil, AST, and ALT level were associated with unresponsiveness to IVIG. Previous studies have shown that these values were higher in non-responders than in responders [17,18,19]. It is remarkable that all these factors have also been incorporated into the existing refractory prediction scores, such as Osaka, Kurume, and Gumma scores [7,8,9].…”

Section: Discussionmentioning

confidence: 99%

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retprospective study

Muto

Nakamura

Masuda

et al. 2020

Preprint

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Background Carnitine plays an essential role in transfer of long-chain fatty acids to mitochondria for subsequent β-oxidation. No studies to date have characterized carnitine in children with KD. The objective of this study is to investigate the characteristics of serum free carnitine (FC) in hospitalized pediatric patients with Kawasaki disease (KD). Methods In total, 45 patients with KD measured the levels of serum FC from October 2018 to December 2019 were analyzed retrospectively. We analyzed the clinical and laboratory parameters just before the Intravenous immunoglobulin (IVIG) including serum levels of serum FC with respect to the IVIG response. Results The median age was 33 months. IVIG was effective in 33 children (responders) and was ineffective in 12 (non-responders). The serum FC levels were higher in non-responders than in responders [(35.3 µmol/L (range, 26.8-118.4 µmol/L) vs. 31.4 µmol/L (range, 20.9–81.2 µmol/L), p value = 0.0496]. The FC levels before intravenous immunoglobulin (IVIG) in four-fifths of responders were below the normal range.The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and FC were higher in non-responders than in responders. There was a correlation between FC and AST (R2 = 0.364, P = 0.0015) and between FC and ALT (R2 = 0.423, P < 0.001) levels. Conclusion FC levels were upregulated in patients with KD who were refractory to IVIG. Additionally, FC levels in children with KD correlated with AST and ALT levels. The pathogenesis resulting in the elevation of FC levels remains elusive. Further studies are necessary to understand more precisely carnitine properties in patients with KD.

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“…In 2011,American scholar Mohammed [1] conducted a retrospective analysis on KD complicated with liver damage for the rst time;this study only described the clinical characteristics and brie y analyzed the relationship between liver damage and related in ammatory indicators;The duration or outcome of hepatic impairment was not described.In 2019,Japanese scholar Tomita analyzed the datas of 381 children with KD admitted to Kobe Medical Center General Hospital from 1983 to 2001,and found that 199/381 cases (52.2%) had liver damage,among which ALT elevation was most notable.And most ALT value reached the peak 1-3 days after the disease onset,returned to normal within 15-17 days. [13]At present,most studies believe that KD complicated with liver damage is only a transient injury,and abnormal liver enzyme markers can be rapidly improved with the control of acute in ammation. [14] However,with the deepening of people's understanding and follow-up of KD,we found that it is not rare that liver damage occurs in the subacute stage and even the recovery stage of the disease.According to a report at the 2014 China Conference, [15]6.7% (13/195) of children had this condition.In our study,the incidence of liver damage after IVIG treatment of KD patients with effective IVIG treatment was 10.8%…”

Section: Discussionmentioning

confidence: 99%

Factors associated with liver injury after intravenous gamma globulin treatment in children with Kawasaki disease

Ren

et al. 2022

Preprint

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Background: The etiology of liver injury in children with Kawasaki disease(KD) is not yet clear.It is common for children who are responded to intravenous gamma globulin (IVIG) therapy to develop liver injury after IVIG treatment. This research is to explore related factors of liver injury after IVIG treatment in children with KD who responded retrospectively to IVIG.Methods: A total of 806 children with KD were included in this analysis. The clinical characteristics, laboratory findings, and drug use before IVIG were collected. Difference analysis, ROC curve analysis and logistic regression analysis were performed to obtain possible risk factors for liver injury after IVIG treatment.Results: Among the clinical symptoms of the two groups of children, children with lymphadenopathy had a lower risk of developing liver injury after IVIG treatment(p=0.040),while there were no significant differences in other symptoms. Among laboratory indicators, the liver injury group had higher levels of platelet(PLT),eosinophil(EO) and brain natriuretic peptide(BNP) levels and lower hemoglobin(HB),erythrocyte sedimentation rate(ESR) and prothrombin time(PT) levels before IVIG treatment (p<0.05).There were no significant difference in c-reactive protein(CRP) and Procalcitonin(PCT)(p>0.05).The use of antibiotics, dipyridamole and aspirin doses between two groups had statistically significant differences(p>0.05).Further ROC curve analysis of aspirin dose found the optimal cut-off point of aspirin was 34.7 mg/(k*d)(the 95% CI: 0.504-0.601,p=0.026).The logistic regression analysis showed high-dose aspirin (≥34.7mg/(kg*d))was a risk factor for liver damage after IVIG treatment in KD children. Further multivariate regression analysis prompted that the use of antibiotics and higher doses of aspirin(≥34.7mg/(kg*d))in the acute phase were independent risk factors for liver injury after IVIG treatment in children with KD(Antibiotic use: OR=2.195,95%CI:1.206-3.994,p=0.01;Aspirin use: OR=1.526,95%CI:1.083-2.151,p=0.016).Conclusions: For KD children with normal liver function in the acute phase, the younger the age of KD onset, the smaller the weight, the absence of lymphadenopathy, and more elevated PLT,EO, BNP, reduced HB,ESR and PT in acute stage, the more likely to develop liver injury after treatment. There was no significant correlation between the degree of systemic inflammation(levels of CRP and PCT)in the acute phase and liver damage after IVIG treatment. The use of antibiotics and high-dose aspirin in the acute phase may be the risk factors for liver function damage after IVIG treatment in KD children.

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Implications of hepatic dysfunction in Kawasaki disease: Time‐related changes in aspartate aminotransferase, alanine aminotransferase, total bilirubin, and C‐reactive protein levels

Cited by 12 publications

References 41 publications

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retrospective study

Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retprospective study

Factors associated with liver injury after intravenous gamma globulin treatment in children with Kawasaki disease

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