Pediatrik Multisistem İnflamatuvar Hastalıkta (MIS-C) Gastrointestinal Sistem Tutulumu: 47 Olgunun Tek Merkez Deneyimi

Öz

Özet Amaç: Pediatrik multisistem inflamatuvar hastalık (MIS-C), koronavirüs 2019 (COVID-19) pandemisi sırasında yeni tanımlanan, ateş, inflamasyon ve çoklu organ yetmezliği ile karakterize hiperinflamatuvar bir sendromdur. Başlıca klinik prezentasyonlardan birisi gastrointestinal sistem tutulumudur. Çalışmanın amacı, gastrointestinal sistem tutulumu olan MIS-C olgularına odaklanarak, gastrointestinal tablonun şiddetine göre klinik seyir ve sonucu değerlendirmektir. Yöntem: Ekim 2020-Mart 2022 tarihleri arasında kliniğimizde gastrointestinal tutulumu olan 47 MIS-C hastasının retrospektif bir çalışmasını gerçekleştirdik. Hastalar gastrointestinal tutulumun şiddetine göre iki gruba ayrıldı. Gruplar demografik özellikler, gastrointestinal semptomlar, laboratuvar parametreleri, diğer sistem tutulumları, hastanede kalış süreleri, tedavi yöntemleri ve klinik sonuçlar açısından karşılaştırıldı. Bulgular: Gastrointestinal sistem tutulumunun ciddiyetine göre olguların %44.7'si (n=21) hafif-orta, %55.3'ü (n=26) şiddetli idi. Başvuru anında en sık görülen gastrointestinal semptomlar karın ağrısı (%78.7), kusma (%59.6) ve bulantı (%55.3) idi. Olguların %29.8'inde transaminaz yüksekliği mevcuttu. En sık radyolojik bulgu asit (%36.2) ve pankreas ödemi (%27.7) idi. Akut pankreatit ile başvuran olgularda (n=9), yoğun bakıma yatış oranları (n=6) istatistiksel olarak anlamlı derecede yüksekti. Brain natriüretik peptid (p=0.020) ve d-dimer (p=0.032), şiddetli grupta, hafif-orta gruba göre istatistiksel olarak anlamlı derecede yüksekti. Sonuç: Gastrointestinal tutulumu olan MIS-C olgularının önemli bir kısmında ciddi bulgular görülmektedir. Özellikle pankreatit ile başvuran olgularda daha ağır bir klinik seyir gözlenebilir. Bu nedenle gastrointestinal semptomlarla prezente olan hastalarda pankreatit açısından değerlendirme gereklidir.

Anahtar Kelimeler

• Pediatrik multisistem inflamatuvar hastalık
• gastrointestinal tutulum
• pankreatit

Gastrointestinal System Involvement of Multisystem Inflammatory Syndrome in Children (MIS-C): A Single Center Experience of 47 cases

Öz

Abstract Backgraound/Aims: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome which was newly described during the coronavirus disease 2019 (COVID-19) pandemic in children and characterized by fever, inflammation, multiorgan dysfunction. One of the major clinical presentation is gastrointestinal system involvement. The aim of the study is to evaluate the clinical course and outcome according to the severity of gastrointestinal presentation, focusing on MIS-C cases with gastrointestinal system involvement. Methods: We performed a retrospective study of 47 MIS-C patients with gastrointestinal involvement in our clinic between October 2020 and March 2022. The patients were divided into two groups according to the severity of gastrointestinal involvement. The groups were compared in terms of demographic characteristics, gastrointestinal symptoms, laboratory parameters, other system involvement, length of hospital stay, treatment modalities, and clinical outcomes. Results: According to the severity of gastrointestinal system involvement, 44.7% (n=21) of the cases were mild to moderate, 55.3% (n=26) were severe. The most common gastrointestinal symptoms at presentation were abdominal pain (78.7%), vomiting (59.6%), and nausea (55.3%). Transaminase elevation was present in 29.8% of the cases. The most common radiological findings were ascites (36.2%) and pancreatic edema (27.7%). In cases presenting with acute pancreatitis (n=9), intensive care unit admission rates (n=6) were statistically significantly higher. Brain natriuretic peptide (p=0.020) and d-dimer (p=0.032) were statistically significantly higher in the severe group than in the mild to moderate group. Conclusions: In a significant part of the MIS-C cases with gastrointestinal involvement, severe findings is observed. Especially in cases presenting with pancreatitis, a more severe clinical course may be observed. Therefore, when managing patients presenting with gastrointestinal symptoms, the evaluation for pancreatitis is essential.

Anahtar Kelimeler

• Multisystem inflammatory syndrome in children
• gastrointestinal involvement
• pancreatitis

Kaynakça

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