Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
Por:
García-Salido A, de Carlos Vicente JC, Belda Hofheinz S, Balcells Ramírez J, Slöcker Barrio M, Leóz Gordillo I, Hernández Yuste A, Guitart-Pardellans C, Cuervas-Mons Tejedor M, Huidobro Labarga B, Vázquez Martínez JL, Gutiérrez Jimeno M, Oulego-Erróz I, Trastoy Quintela J, Medina Monzón C, Medina Ramos L, Holanda Peña MS, Gil-Antón J, Sorribes Ortí C, Flores González JC, Hernández Palomo RM, Sánchez Ganfornina I, Fernández Romero E, García-Besteiro M, López-Herce Cid J and González Cortés R
Publicada:
26 dic 2020
Ahead of Print:
26 nov 2020
Categoría:
Critical care and intensive care medicine
Resumen:
Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.
Filiaciones:
García-Salido A:
Hospital Infantil Universitario Niño Jesús, Madrid, Spain
de Carlos Vicente JC:
Hospital Universitario Son Espases, Palma, Spain
Belda Hofheinz S:
Hospital Universitario 12 de Octubre, Madrid, Spain
Balcells Ramírez J:
Hospital Universitario Vall d'Hebron, Barcelona, Spain
Slöcker Barrio M:
Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain
Leóz Gordillo I:
Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Hernández Yuste A:
Hospital Regional Universitario de Málaga, Málaga, Spain
Guitart-Pardellans C:
Hospital Universitario Sant Joan de Deu, Esplugues de Llobregat, Spain
Cuervas-Mons Tejedor M:
Hospital Universitario de Burgos, Burgos, Spain
Huidobro Labarga B:
Hospital Universitario Virgen de la Salud, Toledo, Spain
Vázquez Martínez JL:
Hospital Universitario Ramón y Cajal, Madrid, Spain
Gutiérrez Jimeno M:
Clínica Universidad de Navarra, Pamplona, Spain
Oulego-Erróz I:
Complejo Asistencial Universitario de León, Leon, Spain
:
Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
Medina Monzón C:
Hospital General Universitario de Albacete, Albacete, Spain
Medina Ramos L:
Hospital General Universitario de Alicante, Alicante, Spain
Holanda Peña MS:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Gil-Antón J:
Hospital Universitario de Cruces, Barakaldo, Spain
Sorribes Ortí C:
Hospital Universitario Joan XXIII, Tarragona, Spain
Flores González JC:
Hospital Universitario Puerta del Mar, Cádiz, Spain
Hernández Palomo RM:
Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Spain
Sánchez Ganfornina I:
Hospital Universitario Virgen del Rocío, Sevilla, Spain
Fernández Romero E:
Hospital Universitario Virgen de la Macarena, Sevilla, Spain
García-Besteiro M:
Parc Tauli Hospital Universitari, Sabadell, Spain
López-Herce Cid J:
Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain
González Cortés R:
Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain.
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