6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital : a retrospective cohort study
Copyright © 2021 Elsevier Ltd. All rights reserved..
BACKGROUND: Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to describe the 6-month outcomes of PIMS-TS.
METHODS: This retrospective cohort study comprised children (aged <18 years) who fulfilled the UK Royal College of Paediatrics and Child Health (RCPCH) diagnostic criteria for PIMS-TS and were admitted to Great Ormond Street Hospital (London, UK) between April 4 and Sept 1, 2020. Patients were followed up by a multidisciplinary team of specialists at 6 weeks and 6 months after admission. Biochemical and functional outcomes were analysed.
FINDINGS: 46 children were included in this study. The median age at presentation was 10·2 years (IQR 8·8-13·3), 30 (65%) patients were male and 16 (35%) were female, 37 (80%) were from minority ethnic groups, and eight (17%) had pre-existing comorbidities. All patients had elevated markers of systemic inflammation at baseline. None of the patients died. By 6 months, systemic inflammation was resolved in all but one patient. 38 (90%) of 42 patients who had positive SARS-CoV-2 IgG antibodies within 6 weeks of admission remained seropositive at 6 months. Echocardiograms were normal in 44 (96%) of 46 patients by 6 months, and gastrointestinal symptoms that were reported in 45 (98%) of 46 patients at onset were present in six (13%) of 46 patients at 6 months. Renal, haematological, and otolaryngological findings largely resolved by 6 months. Although minor abnormalities were identified on neurological examination in 24 (52%) of 46 patients at 6 weeks and in 18 (39%) of 46 at 6 months, we found minimal functional impairment at 6 months (median Expanded Disability Status Scale score 0 [IQR 0-1]). Median manual muscle test-8 scores improved from 53 (IQR 43-64) during hospital admission to 80 (IQR 68-80) at 6 months, but 18 (45%) of 40 patients showed 6-min walk test results below the third centile for their age or sex at 6 months. PedsQL responses revealed severe emotional difficulties at 6 months (seven [18%] of 38 by parental report and eight [22%] of 38 by self report). 45 (98%) of 46 patients were back in full-time education (virtually or face to face) by 6 months.
INTERPRETATION: Despite initial severe illness, few organ-specific sequelae were observed at 6 months. Ongoing concerns requiring physical re-conditioning and mental health support remained, and physiotherapy assessments revealed persisting poor exercise tolerance. Longer-term follow-up will help define the extended natural history of PIMS-TS.
FUNDING: None.
| Errataetall: |
CommentIn: Nat Rev Rheumatol. 2021 Jul;17(7):377. - PMID 34108670 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
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| Enthalten in: |
The Lancet. Child & adolescent health - 5(2021), 7 vom: 24. Juli, Seite 473-482 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abdel-Mannan, Omar [VerfasserIn] |
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| Anmerkungen: |
Date Completed 01.07.2021 Date Revised 13.09.2021 published: Print-Electronic CommentIn: Nat Rev Rheumatol. 2021 Jul;17(7):377. - PMID 34108670 Citation Status MEDLINE |
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| doi: |
10.1016/S2352-4642(21)00138-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325927634 |
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| 245 | 1 | 0 | |a 6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital |b a retrospective cohort study |
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| 500 | |a Date Revised 13.09.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Nat Rev Rheumatol. 2021 Jul;17(7):377. - PMID 34108670 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to describe the 6-month outcomes of PIMS-TS | ||
| 520 | |a METHODS: This retrospective cohort study comprised children (aged <18 years) who fulfilled the UK Royal College of Paediatrics and Child Health (RCPCH) diagnostic criteria for PIMS-TS and were admitted to Great Ormond Street Hospital (London, UK) between April 4 and Sept 1, 2020. Patients were followed up by a multidisciplinary team of specialists at 6 weeks and 6 months after admission. Biochemical and functional outcomes were analysed | ||
| 520 | |a FINDINGS: 46 children were included in this study. The median age at presentation was 10·2 years (IQR 8·8-13·3), 30 (65%) patients were male and 16 (35%) were female, 37 (80%) were from minority ethnic groups, and eight (17%) had pre-existing comorbidities. All patients had elevated markers of systemic inflammation at baseline. None of the patients died. By 6 months, systemic inflammation was resolved in all but one patient. 38 (90%) of 42 patients who had positive SARS-CoV-2 IgG antibodies within 6 weeks of admission remained seropositive at 6 months. Echocardiograms were normal in 44 (96%) of 46 patients by 6 months, and gastrointestinal symptoms that were reported in 45 (98%) of 46 patients at onset were present in six (13%) of 46 patients at 6 months. Renal, haematological, and otolaryngological findings largely resolved by 6 months. Although minor abnormalities were identified on neurological examination in 24 (52%) of 46 patients at 6 weeks and in 18 (39%) of 46 at 6 months, we found minimal functional impairment at 6 months (median Expanded Disability Status Scale score 0 [IQR 0-1]). Median manual muscle test-8 scores improved from 53 (IQR 43-64) during hospital admission to 80 (IQR 68-80) at 6 months, but 18 (45%) of 40 patients showed 6-min walk test results below the third centile for their age or sex at 6 months. PedsQL responses revealed severe emotional difficulties at 6 months (seven [18%] of 38 by parental report and eight [22%] of 38 by self report). 45 (98%) of 46 patients were back in full-time education (virtually or face to face) by 6 months | ||
| 520 | |a INTERPRETATION: Despite initial severe illness, few organ-specific sequelae were observed at 6 months. Ongoing concerns requiring physical re-conditioning and mental health support remained, and physiotherapy assessments revealed persisting poor exercise tolerance. Longer-term follow-up will help define the extended natural history of PIMS-TS | ||
| 520 | |a FUNDING: None | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Abdel-Mannan, Omar |e verfasserin |4 aut | |
| 700 | 1 | |a Grant, Karlie |e verfasserin |4 aut | |
| 700 | 1 | |a Maillard, Sue |e verfasserin |4 aut | |
| 700 | 1 | |a Kucera, Filip |e verfasserin |4 aut | |
| 700 | 1 | |a Hassell, Jane |e verfasserin |4 aut | |
| 700 | 1 | |a Eyre, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Berger, Zoe |e verfasserin |4 aut | |
| 700 | 1 | |a Hacohen, Yael |e verfasserin |4 aut | |
| 700 | 1 | |a Moshal, Karyn |e verfasserin |4 aut | |
| 700 | 0 | |a GOSH PIMS-TS MDT Group |e verfasserin |4 aut | |
| 700 | 1 | |a Wyatt, Michelle |e investigator |4 oth | |
| 700 | 1 | |a Cavalli, Lesley |e investigator |4 oth | |
| 700 | 1 | |a Mathias, Mary |e investigator |4 oth | |
| 700 | 1 | |a Bamford, Alasdair |e investigator |4 oth | |
| 700 | 1 | |a Shingadia, Delane |e investigator |4 oth | |
| 700 | 1 | |a Alders, Nele |e investigator |4 oth | |
| 700 | 1 | |a Grandjean, Louis |e investigator |4 oth | |
| 700 | 1 | |a Gaynor, Edward |e investigator |4 oth | |
| 700 | 1 | |a Brugha, Rossa |e investigator |4 oth | |
| 700 | 1 | |a Stojanovic, Jelena |e investigator |4 oth | |
| 700 | 1 | |a Johnson, Mae |e investigator |4 oth | |
| 700 | 1 | |a Whittaker, Elizabeth |e investigator |4 oth | |
| 700 | 1 | |a Pressler, Ronit |e investigator |4 oth | |
| 700 | 1 | |a Papadopoulou, Charalampia |e investigator |4 oth | |
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