Factors effecting disease severity of multisystem inflammatory syndrome in children

Yıl 2022, , 595 - 602, 01.07.2022

Zahide Ekici Tekin , Müge Sezer , Elif Çelikel , Fatma Aydın , Tuba Kurt , Nilüfer Tekgöz , Cüneyt Karagöl , Serkan Coşkun , Melike Kaplan , Nimet Öner , Merve Cansu Polat , Aysun Yahşi , Serhat Emeksiz , Banu Acar

https://doi.org/10.31362/patd.1114808

Öz

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.

Anahtar Kelimeler

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)

Kaynakça

• 1. XINHUANET. New‐type coronavirus causes pneumonia in Wuhan: expert. Released on 9 January 2020. Available at http://www.xinhuanet.com/english/2020-01/09/c_138690570.htm Erişim tarihi 07.11.2021.
• 2. Guan WJ, Ni ZY, Hu Y, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-1720.
• 3. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-1062.
• 4. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine 2019;180:934-943.
• 5. Zheng J. SARS-CoV-2: an emerging coronavirus that causes a global threat. Int J Biol Sci 2020;16:1678-1685. 6. Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med 2020;382:1663-1665.
• 7. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088-1095.
• 8. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607-1608.
• 9. Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 (COVID-19) at a tertiary care medical center in New York City. J Pediatr 2020;223:14-19.
• 10. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020;395:1771-1778. doi:10.1016/S0140-6736(20)31103-X
• 11.Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. Lancet 2020;395:1741-1743.
• 12. CDC. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). URL: https://emergency.cdc.gov/coca/ppt/2020/COCA_Call_Slides_05_19_2020.pdf Erişim tarihi 07.11.2021.
• 13. World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. May 2020. URL: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 Erişim tarihi 07.11.2021.
• 14. Royal College of Paediatrics and Child Health. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. June 2020. URL: https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims Erişim tarihi 07.11.2021.
• 15. Jonat B, Gorelik M, Boneparth A, et al. Multisystem Inflammatory Syndrome in Children Associated With Coronavirus Disease 2019 in a Children's Hospital in New York City: Patient Characteristics and an Institutional Protocol for Evaluation, Management, and Follow-Up. Pediatr Crit Care Med 2021;22:178-191.
• 16. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010;11:234-238. 17. Belhadjer Z, Méot M, Bajolle F, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation 2020 4;142(5):429-436. doi: 10.1161/CIRCULATIONAHA.120.048360.
• 18. Newbuger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long‐term management of Kawasaki disease: a statement for health professionals from the committee on Rheumatic fever, Endocarditis and Kawasaki disease, council on Cardiovascular disease in the young. American Heart Association. Circulation, 2004;110:2747-2771.
• 19. Henter JI, Horne A, Arico M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007;48:124-131.
• 20. Ravelli A, Minoia F, Davì S, et al. Paediatric Rheumatology International Trials Organization; Childhood Arthritis and Rheumatology Research Alliance; Pediatric Rheumatology Collaborative Study Group; Histiocyte Society. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organization Collaborative Initiative. Ann Rheum Dis 2016;75:481-489.
• 21. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in US children and adolescents. N Engl J Med 2020;383:334-346.
• 22. Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis 2020;79:999-1006.
• 23. Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA 2021 16;325(11):1074-1087. doi: 10.1001/jama.2021.2091.
• 24. Miller AD, Zambrano LD, Yousaf AR, et al. Multisystem Inflammatory Syndrome in Children-United States, February 2020-July 2021. Clin Infect Dis 2021 Dec 5:ciab1007. doi: 10.1093/cid/ciab1007.
• 25. Chiotos K, Bassiri H, Behrens EM, et al. Multisystem inflammatory syndrome in children during the COVID-19 pandemic: a case series. J Pediatric Infect Dis Soc 2020;9:393-398.
• 26. Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324:259-269.
• 27. Torres JP, Izquierdo G, Acuña M, et al. Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. Int J Infect Dis 2020;100:75-81.
• 28. Radia T, Williams N, Agrawal P, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev 2021;38:51-57.
• 29. Dufort EM, Koumans EH, Chow EJ, et al. New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med 2020;383:347-358.
• 30. Deza Leon MP, Redzepi A, McGrath E, et al. COVID-19-Associated Pediatric Multisystem Inflammatory Syndrome. J Pediatric Infect Dis Soc 2020;9:407-408.
• 31. Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol 2020;72:1791-1805.