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

Importance: The cause of the hepatic dysfunction that commonly accompanies Kawasaki disease (KD) remains unclear. Objective: We tried to clarify the cause of the hepatic dysfunction. Methods: A total of 381 consecutive patients with acute KD, who had undergone inpatient treatment with intravenous immunoglobulin until the 7th day of illness, were divided into a group of 199 patients with an alanine aminotransferase (ALT) level ≥ 40 IU/L on admission (group I), a group of 52 patients with an ALT level ≥ 40 IU/L at some point after admission (group II), and a group of 130 patients with ALT levels consistently < 40 IU/L throughout hospitalization (group III). Aspartate aminotransferase (AST), ALT, total bilirubin (T-Bil), and C-reactive protein (CRP) levels were analyzed over time, and time-courses were compared. Results: In the initial stage of illness, in group I, AST, ALT, T-Bil peaked on days 1–3, and AST tended to improve significantly on the 4th day (P < 0.001). T-Bil improved on day 5 (P < 0.01), and ALT improved significantly on day 6 (P < 0.001). CRP increased every day up to day 6 (P < 0.001). In group II, AST and ALT increased after admission, and thereafter CRP increased, then decreased. The frequency of use of aspirin and aspirin doses did not differ significantly in the three groups. Interpretation: Recovery from liver dysfunction occurred in the initial stage of illness in group I—within the period of CRP exacerbation, which is an indicator of systemic inflammation. Key words: Kawasaki disease; Dysbiosis; Fecal calprotectin; Gut inflammation; Pathogenesis; Portal vein