Factors Associated with Liver Injury After Intravenous Gamma Globulin Treatment in Children with Kawasaki Disease
Author(s): Zhipeng Xu, Huan Yu, Biyao Hang, Yuhan Xia, Jie Li, Jianjie Wang, Qihao Zhang, Xiaoshan Zhao, Yue Ren* and Maoping Chu#
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 highdose 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).
Conclusion: 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.