Severe manifestations of SARS-CoV-2 in children and adolescents : from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
García-Salido, Alberto (Hospital Infantil Universitario Niño Jesús (Madrid))
de Carlos Vicente, Juan Carlos (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Belda Hofheinz, Sylvia (Hospital Universitario 12 de Octubre (Madrid))
Balcells Ramírez, Joan (Hospital Universitari Vall d'Hebron)
Slöcker Barrio, María (Hospital General Universitario Gregorio Marañón)
Leóz Gordillo, Inés (Hospital Infantil Universitario Niño Jesús (Madrid))
Hernández Yuste, Alexandra (Hospital Regional Universitario de Málaga)
Guitart Pardellans, Carmina (Hospital Sant Joan de Déu (Manresa))
Cuervas-Mons Tejedor, Maite (Hospital Universitario de Burgos)
Huidobro Labarga, Beatriz (Hospital Virgen de la Salud (Toledo))
Vázquez Martínez, José Luís (Hospital Universitario Ramón y Cajal (Madrid))
Gutiérrez Jimeno, Míriam (Clínica Universidad de Navarra)
Oulego-Erróz, Ignacio (Complejo Asistencial Universitario de León)
Trastoy Quintela, Javier (Complejo Hospitalario Universitario de Santiago de Compostela)
Medina Monzón, Carmen (Complejo Hospitalario Universitario de Albacete)
Medina Ramos, Laura (Hospital General Universitario de Alicante (Alacant, País Valencià))
Holanda Peña, María Soledad (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Gil-Antón, Javier (Hospital Universitario de Cruces (Barakaldo, País Basc))
Sorribes Ortí, Clara (Hospital Universitari Joan XXIII de Tarragona)
Flores González, José Carlos (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Hernández Palomo, Rosa María (Grupo Quirónsalud (Madrid, Espanya))
Sánchez Ganfornina, Inma (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Fernández Romero, Emilia (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
García-Besteiro, María (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
López-Herce Cid, Jesús (Hospital General Universitario Gregorio Marañón)
González Cortés, Rafael (Hospital General Universitario Gregorio Marañón)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0. 002): 9. 4 years (IQR 5. 5-11. 8) vs 3. 4 years (IQR 0. 4-9. 4). A higher proportion of them had no previous medical history of interest (88. 2% vs 51. 7%, p = 0. 005). Non-MIS-C patients presented more frequently with respiratory distress (60. 7% vs 13. 3%, p < 0. 001). MIS-C patients showed higher prevalence of fever (95. 6% vs 64. 3%, p < 0. 001), diarrhea (66. 7% vs 11. 5%, p < 0. 001), vomits (71. 1% vs 23. 1%, p = 0. 001), fatigue (65. 9% vs 36%, p = 0. 016), shock (84. 4% vs 13. 8%, p < 0. 001) and cardiac dysfunction (53. 3% vs 10. 3%, p = 0. 001). MIS-C group had a lower lymphocyte count (p < 0. 001) and LDH (p = 0. 001) but higher neutrophil count (p = 0. 045), neutrophil/lymphocyte ratio (p < 0. 001), C-reactive protein (p < 0. 001) and procalcitonin (p < 0. 001). Patients in the MIS-C group were less likely to receive invasive ventilation (13. 3% vs 41. 4%, p = 0. 005) but were more often treated with vasoactive drugs (66. 7% vs 24. 1%, p < 0. 001), corticosteroids (80% vs 44. 8%, p = 0. 003) and immunoglobulins (51. 1% vs 6. 9%, p < 0. 001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2. 5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.
Ajuts:	Instituto de Salud Carlos III COV20-00944
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Estudi clínic ; recerca
Matèria:	SARS-CoV-2 ; Pediatric multisystem infammatory syndrome temporally associated with COVID-19 ; Kawasaki disease ; Toxic shock syndrome ; Children ; Critical care ; Shock
Publicat a:	Critical Care, Vol. 24 (november 2020) , p. 666, ISSN 1466-609X

DOI: 10.1186/s13054-020-03332-4
PMID: 33243303

13 p, 1.5 MB

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