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.
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Faculdade de Medicina / USP
2020
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oai:scielo:S1807-593220200001002632020-08-17Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndromePereira,Maria Fernanda BadueLitvinov,NadiaFarhat,Sylvia Costa LimaEisencraft,Adriana PasmanikGibelli,Maria Augusta Bento CicaroniCarvalho,Werther Brunow deFernandes,Vinicius RodriguesFink,Thais de ToledoFramil,Juliana Valéria de SouzaGalleti,Karine VusbergFante,Alice LimaFonseca,Maria Fernanda MotaWatanabe,AndreiaPaula,Camila Sanson Yoshino dePalandri,Giovanna GavrosLeal,Gabriela NunesDiniz,Maria de Fatima RodriguesPinho,João Renato RebelloSilva,Clovis ArturMarques,Heloisa Helena de SousaRossi Junior,AlfioDelgado,Artur FigueiredoAndrade,Anarella Penha Meirelles deSchvartsman,ClaudioSabino,Ester CerdeiraRocha,Mussya CisottoKanunfre,Kelly AparecidaOkay,Thelma SuelyCarneiro-Sampaio,Magda Maria SalesJorge,Patricia Palmeira Daenekas COVID-19 Children Adolescent Outcome, Immunosuppression 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.info:eu-repo/semantics/openAccessFaculdade de Medicina / USPClinics v.75 20202020-01-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322020000100263en10.6061/clinics/2020/e2209 |
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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 |
spellingShingle |
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 Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
author_facet |
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 |
author_sort |
Pereira,Maria Fernanda Badue |
title |
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
title_short |
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
title_full |
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
title_fullStr |
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
title_full_unstemmed |
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome |
title_sort |
severe clinical spectrum with high mortality in pediatric patients with covid-19 and multisystem inflammatory syndrome |
description |
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. |
publisher |
Faculdade de Medicina / USP |
publishDate |
2020 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322020000100263 |
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