Abnormal Liver Panel in Acute Kawasaki Disease

Background and Aims: Abnormalities of liver panel (liver function test [LFT]) are frequently documented in patients with Kawasaki disease (KD). We sought to define the spectrum of abnormalities in liver panel tests in children with KD. We studied the characteristics of KD patients who presented with an abnormal liver panel and their response to treatment. Methods: We retrospectively reviewed the medical records of all KD patients admitted between 2004 and 2009 with one or more LFTs done at presentation and compared patients with and without at least 1 abnormal liver panel test including alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, and bilirubin. These patients were divided into 2 groups: those with normal LFTs (normal LFT group) and those with at least one abnormal LFT at presentation (abnormal LFT group). Results: Of 259 patients, 240 (92.7%) patients with KD reviewed had one or more LFTs performed. One hundred nine (45.4%) had at least 1 abnormal liver panel test. Patients in the abnormal LFT group presented earlier (P = 0.01) and were more likely to have intravenous immunoglobulin (IVIG) resistant disease (P = 0.01). There was no significant difference between groups in development of coronary artery abnormalities or aneurysms. Multivariate analysis identified C-reactive protein and total bilirubin at admission as significant predictors for IVIG resistant disease. Conclusion: We report the largest US single center study of the spectrum of liver panel abnormalities in children with acute KD. Abnormalities of LFTs are frequently found in patients with acute KD and children with abnormal LFTs were at higher risk for IVIG resistance.