Clinical Profile of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Admitted to Pediatric Intensive Care Unit

IF 0.5 Q4 PEDIATRICS Journal of Pediatric Intensive Care Pub Date : 2022-07-11 DOI:10.1055/s-0042-1750300
Kenchappa Yashaswini, A. Lalitha, Giri Subramanian Naresh Kanna, John Michael Raj A.
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Abstract

Objectives Multisystem inflammatory syndrome in children (MIS-C) is a post Severe Acute Respiratory Syndrome Coronavirus2 (SARS CoV2) immune dissonance seen in the pediatric population. The current study is an attempt to understand the subtleties of diverse phenotypes, immunotherapeutics, and short-term outcome parameters of MIS-C. Materials and Methods Children admitted to the pediatric intensive care unit (PICU) between 1 month and 18 years, satisfying MIS-C criteria, were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease, and nonspecific phenotypes. Respiratory, vasoactive support, and outcomes were analyzed using appropriate statistical methods. Results Seventy-five children presented with MIS-C during the study period. The mean age was 66 months with 54.6% females. Coronavirus disease (COVID) antibody was positive for 41 (54%), real time-reverse rranscription polymerase chain reaction (RT-PCR) positivity was positive in 16 (21.3%), and rapid antigen test was positive in 10 (13%). Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), and cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including Pediatric Risk of Mortality III score, inflammatory markers, cardiac involvement, need for inotropes, and ventilation. In total, 32% received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation (odds ratio 10.94, confidence interval [2.06, 58.06], p-value <0.005) was noted as an independent predictor of mortality by logistic regression. Conclusion MIS-C showed a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.
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儿科重症监护室收治的SARS-CoV-2相关儿童多系统炎症综合征的临床特征
儿童多系统炎症综合征(multi - system inflammatory syndrome in children, MIS-C)是一种发生在儿童人群中的严重急性呼吸系统综合征冠状病毒2 (SARS CoV2)后的免疫失调。目前的研究试图了解misc的不同表型、免疫治疗和短期结果参数的微妙之处。材料与方法本回顾性观察研究纳入1个月至18岁的儿童重症监护病房(PICU),符合MIS-C标准。他们被分为不同的表型,如休克、川崎病和非特异性表型。采用适当的统计方法对呼吸、血管活性支持和结果进行分析。结果75例患儿在研究期间出现misc。平均年龄66个月,女性占54.6%。冠状病毒病(COVID)抗体阳性41例(54%),实时逆转录聚合酶链反应(RT-PCR)阳性16例(21.3%),快速抗原试验阳性10例(13%)。常见症状包括发热(100%)、皮疹(30%)、结膜充血(29.7%)和心血管(68%伴有休克)受累。休克表型的显著差异包括儿科死亡风险III评分、炎症标志物、心脏受累、肌力药物需求和通气。总共32%的患者接受了免疫球蛋白静脉注射,48%的患者接受了糖皮质激素静脉注射。MIS-C患儿的总死亡率为9(12%)。通过logistic回归发现,机械通气需求(优势比10.94,可信区间[2.06,58.06],p值<0.005)是死亡率的独立预测因子。结论MIS-C表现为明显的心血管累及,需要重症监护和免疫调节治疗。通气组的死亡率较高。
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