May HDL Cholesterol Level Have a Role in The Diagnosis of Kawasaki Disease?

Introduction: Kawasaki disease (KD) is a multisystemic vasculitis that has no specific serum marker. The aim of our study is to evaluate whether the serum lipid profile, specifically HDL cholesterol (HDL-C) level, in KD differs from that in other febrile illnesses and if so, it can be used as a diagnostic tool in distinguishing KD from other febrile illnesses. Materials and Methods: We examined prospectively 41 patients with KD (group 1) and 30 patients with febrile illness of viral or bacterial origin (group 2). The patients' demographic and clinical characteristics were analyzed. All blood samples were taken during the disease's acute phase. After fasting for four hours in infants and eight hours in young children, serum total cholesterol, HDL-C, triglyceride (TG), C-reactive protein (CRP), complete blood count, and other biochemical markers were determined. Group 1 was further divided into subgroups as incomplete vs complete cases and patients with vs without coronary artery involvement. Results: Mean serum HDL-C level in KD group was significantly lower than in the febrile illness group (13.8 +/- 8.8 mg/dL vs 37.6 +/- 18.7 mg/dL, p <0.001). A statistically significant difference in TG levels was also present between both groups (group 1: 183 +/- 96 mg/dL vs group 2: 121 +/- 70 mg/dL, p=0.001). We detected a significant difference in terms of HDL-C levels, erythrocyte sedimentation rates, CRP, and TG levels between patients with febrile illness, complete KD, and incomplete KD (p <0.001; p=0.007, p <0.001, p=0.01, respectively). The most appropriate cut-off value of serum HDL-C level for affirming KD was <= 23 mg/dL. The area under the curve was 0.88 (95% confidence interval: 0.78-0.94, p <0.001). Conclusion: The study showed that serum HDL-C level is lower in patients with KD than in those with acute febrile infectious disease. Presence of low serum HDL-C level (<= 23mg\dL) may be helpful in establishing the diagnosis of incomplete KD.