The prognostic role of abnormal liver function in IVIG unresponsiveness in Kawasaki disease: a meta-analysis

We aimed to assess the prognostic role of liver function alteration with intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) by systematically analyzing and summarizing the results from published studies. In this study, we summarized the evidence currently available up to March 31, 2015, and calculated the standard mean difference (SMD) of liver function parameters, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and total bilirubin between IVIG-responsive and IVIG-resistant patients. We found that the serum levels of these parameters in IVIG-non-responsive patients were significantly higher than that in IVIG-responsive group (total bilirubin: SMD = 0.984, 95 %CI 0.712-1.184, p < 0.005; ALT: SMD = 0.555, 95 %CI 0.400-0.710, p < 0.005; AST: SMD = 0.602, 95 %CI 0.413-0.791, p < 0.005; GGT = 0.551, 95 %CI 0.157-0.946, p = 0.006). There was evidence of heterogeneity (I (2) > 50 %). The characteristics of patients could be the major sources, as analysis stratified by region significantly removed or reduced the heterogeneity. In summary, our meta-analysis suggested that liver abnormality was significantly associated with IVIG unresponsiveness in KD patients. Further study from more clinical investigations is needed to confirm this finding.