Multicolored MIS-C, a single-centre cohort study

Springer Science and Business Media LLC
Pál S. Varga1, András Balajthy1, Erika Bíró1, B Bíró1, Zsolt Reiger1, Edit Szikszay1, Gábor Mogyorósy1, Rita Káposzta1, Tamás Szabó1
1Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary

Tóm tắt

Abstract Background The aim of this study was to investigate the clinical and laboratory parameters that can predict the severity of Multisystem Inflammatory Syndrome in Children (MIS-C) at admission. Methods We conducted a single-center, partly retrospective, partly prospective, observational cohort study between November 1, 2020 and December 31, 2021, which included patients aged from 1 month to 19 years, meeting the diagnostic criteria of MIS-C. We categorized the patients into three subgroups based on clinical and laboratory markers and assessed the predictive value of these factors in terms of ICU administration and cardiac abnormalities. Results 53 patients were classified in the following subgroups: Kawasaki-like disease (group 1) (47.2%, n = 25), shock with or without acute cardiac dysfunction (group 2) (32%, n = 17), fever and inflammation (group 3) (20.8%, n = 11). Subgroup analysis revealed that patients with shock and KD at initial presentation had significantly more severe manifestation of MIS-C requiring intensive care unit (ICU) treatment. Of the initial laboratory values, only CRP showed a significant difference between the 3 clinical groups, being lower in group 3. 52.6% of patients were admitted to the ICU. The median length of ICU stay was 3 days (range 3–20). ICU admission was more likely in patients with shortness of breath, renal failure (AKI) and patients with significantly increased concentrations of ferritin, D-dimer, INR and significantly milder increase concentration of fibrinogen. We found that fibrinogen and ferritin levels are independent risk factors for ICU admission. Cardiac abnormalities were found in 56.6% of total (30/53), with the following findings: decreased left ventricular function (32%), coronary abnormality (11.3%), pericardial effusion (17%), arrhythmia (32.1%) and mitral regurgitation (26.6%). Diarrhea and conjunctivitis at the initial presentation with significantly elevated CRP, Pro-BNP and blood pH concentrations were found to be a potential predisposing factor for decreased cardiac function while Pro-BNP and pH were independent risk factors for MIS-C. Regardless of the initial symptoms of MIS-C, the outcome was generally favorable. Conclusions Clinical characteristics and baseline laboratory values ​​may help identify patients at increased risk for severe disease outcome, such as need for intensive care, presence of shock and decreased cardiac function. Trial registration Participation consent was not reqired and ethical considerations were unnecessary, since we did not perform any extra interventions, only the necessary and usual therapeutic and diagnostic methods were used.

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Tài liệu tham khảo

Castagnoli R, Votto M, Licari A, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020;174:882–9.

Verdoni L, Mazza A, Gervasoni A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395:1771–8.

Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607–8.

Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a Pediatric Inflammatory Multisystem Syndrome temporally Associated with SARS-CoV-2. JAMA. 2020;324:259–69.

Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–46.

Royal College of Paediatrics and Child Health Guidance. : Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 [Internet]. RCPCH. Available from: https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims. Accessed 20 Jul 2020.

Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) [Internet]. 2020. Available from: https://emergency.cdc.gov/han/2020/han00432.asp. Accessed 20 Jul 2020.

World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 [Internet]. [cited 2020 Jul 29]. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

Dufort EM, Koumans EH, Chow EJ, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347–58.

Levi Hosta, Paemel RV, Haerynck F. Multisystem inflammatory syndrome in children realated to Covid-19: a systematic review. Eur J Pediatr. 2021;180:2019–34.

Godfred-Cato S, Bryant B, Leung J, et al. COVID-19-Assiciated Multisystem Inflammatory Syndrome in Children – United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1074–80.

Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine. 2020;26:100527.

Nakra NA, Blumberg DA, Herrera-Guerra A, et al. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children. 2020;7:69.

Gerall CD, Duron VP, Griggs CL, et al. Multisystem inflammatory syndrome in Children Mimicking Surgical Pathologies what surgeons need to know about MIS-C. Ann Surg. 2021;273:146–8.

Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: a systematic review. J Pediatr. 2020;226:45–54.

Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: version 2. Arthritis Rheumatol. 2021;73:13–29.

American Academy of Pediatrics clinical guidance. : Multisystem Inflammatory Syndrome in Children (MIS-C), available from: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance. Accessed on November 23, 2020.

Harwood R, Allin B, Jones CE, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health. 2021;5:133–41.

Henderson La, Canna SW, Friedman KG, et al. American College of Rheumatology: Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19: Version 3. Arthritis Rheumatol. 2022;74(4):e1–e20.

Abrams JY, Matthew E, Oster MO, Shana E, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health. 2021;5:323–31.

Zhao Y, Patel J, Huang Y, et al. Cardiac markers of multisystem inflammatory syndrome in children (MIS-C) in COVID-19 patients: a meta-analysis. Am J Emerg Med. 2021;49:62–70.

McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135:927–99.

Jonat B, Gorelik M, Boneparth A, et al. Multisystem inflammatory syndrome in Children Associated with Coronavirus Disease 2019 in a children’s hospital in New York City: patient characteristics and an institutional protocol for evaluation, management, and Follow-Up. Pediatr Crit Care Med. 2021;22:178–e191.

Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA. 2021;325:855–64.

Zhao Y, Yin L, Patel J, et al. The inflammatory markers of multisystem inflammatory syndrome in children (MIS-C) and adolescents associatedvwith COVID-19: A meta-analysis. J Med Virol. 2021; 93:4358–4369.

Wu J-R, Chen I-C, Dai Z-K, et al. Early elevated B-Type natriuretic peptide levels are Associated with Cardiac Dysfunction and Poor Clinical Outcome in Pediatric Septic Patients. Acta Cardiol Sin. 2015;31:485–93.

Consiglio CR, Cotugno N, Sardh F, Pou C, et al. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell. 2020;183:968–81.

Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020;20:453–4.

Rodríguez-Rubio M, Menéndez-Suso JJ, Cámara-Hijón C et al. Cytokine Profile in Children with Severe Multisystem Inflammatory Syndrome Related to the Coronavirus Disease 2019.Online J Pediatr Intensive Care. February24, 2021.

Roasted CA, Chahroudi A, Mantus G, et al. Quantitative SARS-CoV-2 Serology in Children with Multisystem Inflammatory Syndrome (MIS-C). Pediatrics. 2020;146:e2020018242.

Cheung EW, Zachariah P, Gorelik M, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA. 2020;324:294–6. https://doi.org/10.1001/jama.2020.

Niaz T, Hope K, Fremed M et al. Role of a Pediatric Cardiologist in the COVID 19 Pandemic.Pediatr Cardiol. 2020; Oct4:1–17.

Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM, Newburger JW, de Ferranti S, Friedman KG. Review of Cardiac involvement in Multisystem Inflammatory Syndrome in Children. Circulation. 2021;143:78–88. https://doi.org/10.1161/CIRCULATIONAHA.120.049836.

Kaushik A, Gupta S, Sood M, et al. A systematic review of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39:340–6.

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