title: Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Yi
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Jung Yun
authors.initials: JY
authors.lastname: Choi
authors.affiliation: 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. hryang@snubh.org.
authors.forename: Hye Ran
authors.initials: HR
authors.lastname: Yang
mesh_terms: D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D016756:Immunoglobulins, Intravenous