Factors effecting disease severity of multisystem inflammatory syndrome in children

Abstract

Purpose: Multisystem inflammatory syndrome that occurs after SARS-Cov-2 infection with fever, cardiogenic shock and hyperinflammation in children, can be life threatening. In this study, it was aimed to investigate the effects of the complaint and duration at diagnosis on the severity of multisystem inflammatory syndrome in children.
Materials and methods: The medical records of 99 pediatric patients, who were diagnosed multisystem inflammatory syndrome between September 2020 and August 2021 according to Centers for Disease Control and Prevention, were evaluated retrospectively. Demographic features, initial findings, and admission time of patients were noted. Patients were categorized according to intensive care necessity.
Results: The median age of the patients was 10 (2-18) and 62 (62.6%) of patients were male. The median duration before admission was 4 (1-10) days. All patients has fever, 81.8% had gastrointestinal and 75.8% had cardiovascular involvement at admission. The patients (56.6%) who were accepted as severe and moderate MIS-C required intensive care. Prolonged fever, delayed admission, cardiovascular involvement, high inflammatory markers, lymphopenia and thrombocytopenia were found to key parameters determining the need for intensive care.
Conclusion: Multisystem inflammatory syndrome in children is a new disease characterized by fever, signs of inflammation and organ dysfunction associated with SARS-CoV-2 infection. Delayed admission, high cardiac and inflammatory markers at diagnosis increase the need for intensive care.

Keywords

• Fever
• COVID-19
• hyper inflammation
• cardiogenic insufficient
• multisystem inflammatory syndrome in children (MIS-C)

Multisistem inflamatuar sendromlu çocuklarda hastalık şiddetini etkileyen faktörler

Öz

Amaç: Çocuklarda SARS-Cov-2 enfeksiyonu sonrasında ateş, kardiyojenik şok ve hiperinflamasyon bulguları ile gelişen multisistem inflamatuar sendrom tablosu yaşamı tehdit edici olabilmektedir. Bu çalışma ile multisistem inflamatuar sendrom tanısı alan hastaların başvuru şikayet ve sürenin hastalık şiddetine etkisini araştırmak amaçlandı.
Gereç ve yöntem: Eylül 2020-Ağustos 2021 tarihleri arasında merkezimizde Hastalık Kontrol ve Önleme Merkezleri (CDC) vaka tanımı ile multisistem inflamatuar sendrom tanısı alan 99 çocuk hasta tıbbi kayıtları geriye dönük olarak değerlendirildi. Demografik özellikleri, başlangıç klinik bulguları, başvuru süreleri not edildi. Hastalar yoğun bakım ihtiyacına göre sınıflandırıldı.
Bulgular: Hastaların medyan yaşı 10 (6-14) ve %62,6’sı erkekti. Tanıdan önceki medyan semptom süresi 4 (3-5) gündü. Başvuru sırasında hastaların tümünde ateş, %81,8’inde gastrointestinal ve %75,8’inde kardiyovasküler tutulum mevcuttu. Ağır ve orta şiddette MİS-C olarak değerlendirilen %56,6 hastanın yoğun bakım gereksinimi oldu. Ateş süresinin uzun olması, sağlık kuruluşuna gecikmiş başvuru, hastanın kardiyovasküler etkileniminin ön planda olması, yüksek inflamatuvar belirteçler, lenfopeni ve trombositopeni varlığı yoğun bakım gereksinimini etkileyen önemli parametreler olarak bulundu.
Sonuç: Çocuklarda multisistem inflamatuar sendrom, SARS-CoV-2 enfeksiyonu ile ilişkili ateş, inflamasyon belirtileri ve organ disfonksiyonu ile karakterize yeni bir hastalıktır. Gecikmiş başvuru ile uzamış ateş, ilk başvuru anında kardiyak ve inflamatuar belirteçlerin yüksek olması yoğun bakım gereksinimini artırmaktadır.

Anahtar Kelimeler

• Ateş
• COVID-19
• hiperinflamasyon
• kalp yetmezliği
• çocuklarda multisistem inflamatuvar sendrom (MİS-C)

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