Biochemical outcomes and safety profiles of compound glycyrrhizin versus magnesium isoglycyrrhizinate in Kawasaki disease: a retrospective propensity score‑matched cohort study.

Background: Hepatic dysfunction is a common extra-cardiac manifestation of Kawasaki disease (KD). Compound glycyrrhizin (CG) and magnesium isoglycyrrhizinate (MgIG) are widely used hepatoprotective agents in Asian populations. However, no study has directly compared their efficacy and safety in pediatric KD patients with liver enzyme abnormalities. This study aims to compare the biochemical outcomes and safety profiles of CG versus MgIG in KD children with elevated liver enzymes, and to identify factors associated with treatment response. Methods: This retrospective cohort study included KD inpatients with alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) levels >2 times the upper limit of normal (ULN) who received monotherapy with either CG or MgIG. Propensity score matching (PSM) at a 2:1 ratio was applied to balance baseline characteristics. Biochemical responses were assessed by the absolute changes in ALT and AST from baseline to 1 week, as well as by categorical responses (complete normalization and partial biochemical response). A multivariable logistic regression model was used to evaluate the independent association between treatment group and partial biochemical response, adjusting for gender, timing of treatment initiation, and intravenous immunoglobulin (IVIG) resistance. Safety profiles were also compared. Results: After PSM, 129 patients (CG: n=80; MgIG: n=49) were analyzed. Both treatments were associated with significant reductions in ALT and AST from baseline (all P<0.001), with no significant between‑group differences in absolute changes (ALT: P=0.07; AST: P=0.11). Partial biochemical response at 1 week was observed in 86.25% of CG patients and 69.39% of MgIG patients (P=0.02). However, after adjusting for gender, timing of treatment initiation, and IVIG resistance, treatment group was not independently associated with partial biochemical response [odds ratio (OR) =0.542, 95% confidence interval (CI): 0.203-1.452, P=0.22]. Each 1‑day delay in treatment initiation was associated with a 19% reduction in the odds of response, making it the only significant independent predictor. Adverse events were reported in 3.75% of CG patients and 4.08% of MgIG patients, with no serious events and no significant between‑group difference (P>0.99). Conclusions: In this retrospective PSM cohort study, both CG and MgIG were associated with significant biochemical improvements from baseline. After adjustment for confounders, no independent association was found between treatment group and partial biochemical response. Earlier initiation of hepatoprotective therapy was the only factor significantly associated with better biochemical outcomes.