Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

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.

Bibliographic Details

Main Authors:	Pereira,Maria Fernanda Badue, Litvinov,Nadia, Farhat,Sylvia Costa Lima, Eisencraft,Adriana Pasmanik, Gibelli,Maria Augusta Bento Cicaroni, Carvalho,Werther Brunow de, Fernandes,Vinicius Rodrigues, Fink,Thais de Toledo, Framil,Juliana Valéria de Souza, Galleti,Karine Vusberg, Fante,Alice Lima, Fonseca,Maria Fernanda Mota, Watanabe,Andreia, Paula,Camila Sanson Yoshino de, Palandri,Giovanna Gavros, Leal,Gabriela Nunes, Diniz,Maria de Fatima Rodrigues, Pinho,João Renato Rebello, Silva,Clovis Artur, Marques,Heloisa Helena de Sousa, Rossi Junior,Alfio, Delgado,Artur Figueiredo, Andrade,Anarella Penha Meirelles de, Schvartsman,Claudio, Sabino,Ester Cerdeira, Rocha,Mussya Cisotto, Kanunfre,Kelly Aparecida, Okay,Thelma Suely, Carneiro-Sampaio,Magda Maria Sales, Jorge,Patricia Palmeira Daenekas
Format:	Digital revista
Language:	English
Published:	Faculdade de Medicina / USP 2020
Online Access:	http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322020000100263
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