Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

BMC Pediatrics

Juan-Manuel Anaya¹  Martha I Alvarez-Olmos²  Jaime Piracoca Mejìa³  Rafael Orozco Marun⁴  Hernando Mulett-Hoyos⁵  Otto González-Pardo⁶  Carolina Bonilla Gonzalez⁷  Helen Preciado⁸  Juan Camilo Jaramillo-Bustamante⁹  Liliana Mazzillo Vega^1,10  Beatriz Giraldo Duran^1,11  Ledys Izquierdo^1,12  Carolina Giraldo Alzate^1,13  Jorge Rojas^1,14  Eliana Zemanate^1,15  Shayl Chacón^1,16  Jose Luis Junco González^1,17  Byron Enrique Piñeres-Olave^1,18  Ivan Jose Ardila Gomez^1,19  Lorena Acevedo^2,20  Jaime Fernández-Sarmiento^2,21  Laura Fernanda Niño-Serna^2,22  Juan Carlos Salazar-Uribe^2,23 

[1] Center for Autoimmune Disease Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia;Department of Pediatrics and Infectious Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Clínica Infantil de Colsubsidio, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Clínica Portoazul, Puerto Colombia, Colombia;Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Fundación Clínica Shaio, Universidad Nacional de Colombia, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Fundación Santa Fe de Bogotá, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Fundación Universitaria de Ciencias de la Salud. Hospital de San José, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network, Medellín, Colombia;Department of Pediatrics and Intensive Care, Hospital Infantil Los Ángeles, Pasto, Colombia;Department of Pediatrics and Intensive Care, Hospital Infantil de la Cruz Roja Rafael Henao Toro, Manizales, Colombia;Department of Pediatrics and Intensive Care, Hospital Militar Central, Hospital Santa Clara, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Hospital Pablo Tobón Uribe, Medellín, Colombia;Department of Pediatrics and Intensive Care, Hospital Santa Clara, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Hospital Susana Lopez de Valencia, Universidad del Cauca, Popayán, Colombia;Department of Pediatrics and Intensive Care, Hospital Universitario San Ignacio, Bogotá, Colombia;Department of Pediatrics and Intensive Care, Instituto Roosevelt, Bogotá, Colombia;Department of Pediatrics and Intensive Care. Clínica CardioVID, Medellín, Colombia;Department of Pediatrics and Intensive Care. Clínica Uros, Neiva, Colombia;Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia;Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia;Universidad CES Graduate School, Medellín, Colombia;Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía, Cundinamarca, Colombia;Department of Pediatrics. Hospital Pablo Tobón Uribe, Universidad de Antioquia, Medellín, Colombia;Research Group in Statistics, Universidad Nacional de Colombia, Medellín, Colombia;

关键词: Sepsis;    SARS-CoV2;    PIMS-TS;    inflammatory;    mortality;   

DOI  :  10.1186/s12887-021-02974-9

来源: Springer

【 摘 要 】

BackgroundThe clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes.MethodsAn observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C.ResultsThere were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %).ConclusionsMultisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

【 授权许可】

CC BY