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
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Critical care (London, England) - 24(2020), 1 vom: 26. Nov., Seite 666 |
| Sprache: |
Englisch |
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| Links: |
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| Anmerkungen: |
Date Completed 11.12.2020 Date Revised 14.12.2020 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-020-03332-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318098199 |
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| 041 | |a eng | ||
| 100 | 1 | |a García-Salido, Alberto |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Severe manifestations of SARS-CoV-2 in children and adolescents |b from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 11.12.2020 | ||
| 500 | |a Date Revised 14.12.2020 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Children | |
| 650 | 4 | |a Critical care | |
| 650 | 4 | |a Kawasaki disease | |
| 650 | 4 | |a Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Shock | |
| 650 | 4 | |a Toxic shock syndrome | |
| 700 | 1 | |a de Carlos Vicente, Juan Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Belda Hofheinz, Sylvia |e verfasserin |4 aut | |
| 700 | 1 | |a Balcells Ramírez, Joan |e verfasserin |4 aut | |
| 700 | 1 | |a Slöcker Barrio, María |e verfasserin |4 aut | |
| 700 | 1 | |a Leóz Gordillo, Inés |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández Yuste, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Guitart Pardellans, Carmina |e verfasserin |4 aut | |
| 700 | 1 | |a Cuervas-Mons Tejedor, Maite |e verfasserin |4 aut | |
| 700 | 1 | |a Huidobro Labarga, Beatriz |e verfasserin |4 aut | |
| 700 | 1 | |a Vázquez Martínez, José Luís |e verfasserin |4 aut | |
| 700 | 1 | |a Gutiérrez Jimeno, Míriam |e verfasserin |4 aut | |
| 700 | 1 | |a Oulego-Erróz, Ignacio |e verfasserin |4 aut | |
| 700 | 1 | |a Trastoy Quintela, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Medina Monzón, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Medina Ramos, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Holanda Peña, María Soledad |e verfasserin |4 aut | |
| 700 | 1 | |a Gil-Antón, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Sorribes Ortí, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a Flores González, José Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández Palomo, Rosa María |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez Ganfornina, Inma |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández Romero, Emilia |e verfasserin |4 aut | |
| 700 | 1 | |a García-Besteiro, María |e verfasserin |4 aut | |
| 700 | 1 | |a López-Herce Cid, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a González Cortés, Rafael |e verfasserin |4 aut | |
| 700 | 0 | |a Spanish Pediatric Intensive Care Society working group on SARS-CoV-2 infection |e verfasserin |4 aut | |
| 700 | 1 | |a Slöcker Barrio, María |e investigator |4 oth | |
| 700 | 1 | |a Bustinza Arriortua, Amaya |e investigator |4 oth | |
| 700 | 1 | |a López-Herce Cid, Jesús |e investigator |4 oth | |
| 700 | 1 | |a González Cortés, Rafael |e investigator |4 oth | |
| 700 | 1 | |a de Carlos Vicente, Juan Carlos |e investigator |4 oth | |
| 700 | 1 | |a Cuervas-Mons Tejedor, Maite |e investigator |4 oth | |
| 700 | 1 | |a Oyágüez Ugidos, Pedro Pablo |e investigator |4 oth | |
| 700 | 1 | |a Jordan, Iolanda |e investigator |4 oth | |
| 700 | 1 | |a Guitart Pardellans, Carmina |e investigator |4 oth | |
| 700 | 1 | |a Sanchíz Cárdenas, Sonia |e investigator |4 oth | |
| 700 | 1 | |a Gil-Antón, Javier |e investigator |4 oth | |
| 700 | 1 | |a Joyanes, Belén |e investigator |4 oth | |
| 700 | 1 | |a Jiménez Olmos, Ainhoa |e investigator |4 oth | |
| 700 | 1 | |a Rodríguez Núñez, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Trastoy Quintela, Javier |e investigator |4 oth | |
| 700 | 1 | |a Hernández Yuste, Alexandra |e investigator |4 oth | |
| 700 | 1 | |a Díaz Munilla, Laura |e investigator |4 oth | |
| 700 | 1 | |a Solís Reyes, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Medina Ramos, Laura |e investigator |4 oth | |
| 700 | 1 | |a Roca Pascual, David |e investigator |4 oth | |
| 700 | 1 | |a Ballcels Ramírez, Joan |e investigator |4 oth | |
| 700 | 1 | |a Sánchez Fernández, Mario |e investigator |4 oth | |
| 700 | 1 | |a García-Salido, Alberto |e investigator |4 oth | |
| 700 | 1 | |a Leóz Gordillo, Inés |e investigator |4 oth | |
| 700 | 1 | |a Nieto Moro, Montserrat |e investigator |4 oth | |
| 700 | 1 | |a Martínez de Azagra Garde, Amelia |e investigator |4 oth | |
| 700 | 1 | |a García Teresa, María Ángeles |e investigator |4 oth | |
| 700 | 1 | |a Rey Galán, Corsino |e investigator |4 oth | |
| 700 | 1 | |a Molina Cambra, Alfredo |e investigator |4 oth | |
| 700 | 1 | |a González-Ripoll Garzón, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Fernández-Cantalejo Padial, Pepe |e investigator |4 oth | |
| 700 | 1 | |a Oulego-Erroz, Ignacio |e investigator |4 oth | |
| 700 | 1 | |a Vega Puyal, Laia |e investigator |4 oth | |
| 700 | 1 | |a Moreno, Daniel |e investigator |4 oth | |
| 700 | 1 | |a Fernández Romero, Emilia |e investigator |4 oth | |
| 700 | 1 | |a García Besteiro, María |e investigator |4 oth | |
| 700 | 1 | |a Flores González, José Carlos |e investigator |4 oth | |
| 700 | 1 | |a Medina Monzón, Carmen |e investigator |4 oth | |
| 700 | 1 | |a Huidobro Labarga, Beatriz |e investigator |4 oth | |
| 700 | 1 | |a Hernández Palomo, Rosa María |e investigator |4 oth | |
| 700 | 1 | |a Calvo Monge, Cristina |e investigator |4 oth | |
| 700 | 1 | |a Fernández, Francisco |e investigator |4 oth | |
| 700 | 1 | |a González, Nieves |e investigator |4 oth | |
| 700 | 1 | |a Bermúdez Barrezueta, Lorena |e investigator |4 oth | |
| 700 | 1 | |a Villa Francisco, Cesar |e investigator |4 oth | |
| 700 | 1 | |a Abril Molina, Ana |e investigator |4 oth | |
| 700 | 1 | |a Valeron, Mónica |e investigator |4 oth | |
| 700 | 1 | |a Hernández Rastrollo, Ramón |e investigator |4 oth | |
| 700 | 1 | |a Belda Hofheinz, Sylvia |e investigator |4 oth | |
| 700 | 1 | |a Gijón Mediavilla, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Vázquez Martínez, José Luis |e investigator |4 oth | |
| 700 | 1 | |a Frias, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Montero Yéboles, Raúl |e investigator |4 oth | |
| 700 | 1 | |a Muñóz Bonet, Juan Ignacio |e investigator |4 oth | |
| 700 | 1 | |a Velázquez, María |e investigator |4 oth | |
| 700 | 1 | |a Sánchez Ganfornina, Inma |e investigator |4 oth | |
| 700 | 1 | |a Pérez Iranzo, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Lozano, David |e investigator |4 oth | |
| 700 | 1 | |a Sorribes Ortí, Clara |e investigator |4 oth | |
| 700 | 1 | |a Holanda Peña, María Soledad |e investigator |4 oth | |
| 700 | 1 | |a Gutiérrez Jimeno, Miriam |e investigator |4 oth | |
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