Background and objectives: Endogenous cortisol (CRS) increases in a variety of inflammatory diseases and vasculitis syndrome, and recognized as a one of risk factors of disease progression. Although only one previous study reported that CRS level is elevated in acute Kawasaki disease (KD), the predictive value of CRS in KD has not been fully investigated. The aim of this study is to evaluate whether serum CRS levels can predict initial treatment response and development of coronary artery abnormalities (CAAs) in the acute phase of KD.
Materials and Methods: A retrospective study was designed to evaluate serum CRS levels in 92 children with acute KD who were admitted between December 2011 and May 2014. The subjects consisted of 46 males and 46 females aged from 1 month to 12 years (median, 2 years). Serum CRS levels were measured before the initial treatment of IVIG. With Kobayashi score for predicting IVIG resistance, patients were divided into high (Kobayashi Score≧5) and low risk (Kobayashi Score <5) group. Coronary artery diameter was measured at weeks 1, 2, 4 and we calculated maximum Z-score. CAAs were defined as equal to greater than 2.5 of Z-score.
Results: Serum CRS level was 32.7μg/dl (median, 6.2 to 139μg/dl) which is higher than healthy children (5 to 25μg/dl), and significantly elevated in high risk group (median, 41.3μg/dl ) than those in low risk group (median, 27.1μg/dl, p=0.003).
In patients with CAAs CRS level was higher than those without CAAs (Z<2.5 vs Z≧2.5, median 30.4 vs 37.3μg/dl, p=0.052). Additionally, 1 patient who had maximum cortisol level (139μg/dl) showed CAAs (Z-score, seg1: 9.1, seg5: 10.2 at week 4). CRP, WBC counts, and albumin level had no significant correlation with CRS.
Conclusions: We conclude that serum CRS before IVIG were significantly higher in patients with high risk group. CRS may be a potential predictor for developing CAAs.