Multisystem Inflammatory Syndrome in Children: An International Survey
Por:
Bautista-Rodriguez C, Sanchez deToledo J, Clark BC, Herberg J, Bajolle F, Randanne PC, Salas-Mera D, Foldvari S, Chowdhury D, Munoz R, Bianco F, Singh Y, Levin M, Bonnet D and Fraisse A
Publicada:
1 feb 2021
Ahead of Print:
24 nov 2020
Categoría:
Pediatrics, perinatology and child health
Resumen:
An international survey about presentation, risk factors, and outcome of children diagnosed with multisystem inflammatory syndrome temporally associated with SARS-CoV-2 was conducted.
OBJECTIVES: To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C). METHODS: Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management. RESULTS: We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 +/- 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82; P < .0001) increased risk per day reduction respectively. CONCLUSIONS: In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.
Filiaciones:
Bautista-Rodriguez C:
Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
National Heart and Lung Institute and
Contributed equally as co-first authors
Sanchez deToledo J:
Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
Department of Critical Care Medicine, University of Pittsburg Medical Center Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
Contributed equally as co-first authors
Clark BC:
Division of Cardiology, Children's Hospital at Montefiore, New York, New York
Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
Herberg J:
Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, United Kingdom
Bajolle F:
M3C-Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
Université de Paris, Paris, France
Randanne PC:
Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
Salas-Mera D:
Department of Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain
Foldvari S:
Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
National Heart and Lung Institute and
Chowdhury D:
Cardiology Care for Children, Lancaster, Pennsylvania
Munoz R:
Cardiac Critical Care Medicine, Children's National Hospital, Washington, District of Columbia
Bianco F:
AOU Ospedali Riuniti, Ancona, Italy
Singh Y:
NICU, Cambridge University Hospitals, Cambridge, United Kingdom
and
School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
Levin M:
Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, United Kingdom
Bonnet D:
M3C-Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
Université de Paris, Paris, France
Fraisse A:
Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
a.fraisse
National Heart and Lung Institute and
Bronze
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