Article ; Online: Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome.
2020 Volume 75, Page(s) e2209
Abstract: Objectives: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C).: Methods: This cross-sectional study included 471 samples ... ...
Abstract | Objectives: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). Methods: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. Results: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. Conclusions: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia. |
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MeSH term(s) | Abdominal Pain/etiology ; Betacoronavirus ; COVID-19 ; Child ; Coronavirus ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/mortality ; Coronavirus Infections/therapy ; Cross-Sectional Studies ; Diarrhea/etiology ; Fever/etiology ; Glucocorticoids/therapeutic use ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Male ; Mucocutaneous Lymph Node Syndrome/epidemiology ; Mucocutaneous Lymph Node Syndrome/therapy ; Mucocutaneous Lymph Node Syndrome/virology ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/mortality ; Pneumonia, Viral/therapy ; Respiration, Artificial ; SARS-CoV-2 ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/therapy ; Systemic Inflammatory Response Syndrome/virology ; Vomiting/etiology |
Chemical Substances | Glucocorticoids ; Immunoglobulins, Intravenous |
Keywords | covid19 |
Language | English |
Publishing date | 2020-08-19 |
Publishing country | United States |
Document type | Journal Article |
ZDB-ID | 2182801-5 |
ISSN | 1980-5322 ; 1807-5932 |
ISSN (online) | 1980-5322 |
ISSN | 1807-5932 |
DOI | 10.6061/clinics/2020/e2209 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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