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Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome.
Clinics (Sao Paulo). 2020; 75:e2209.C

Abstract

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.

Authors+Show Affiliations

Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Faculdade Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto de Tratamento do Cancer Infantil, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Laboratorio de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.Faculdade Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32844958

Citation

Pereira, Maria Fernanda Badue, et al. "Severe Clinical Spectrum With High Mortality in Pediatric Patients With COVID-19 and Multisystem Inflammatory Syndrome." Clinics (Sao Paulo, Brazil), vol. 75, 2020, pp. e2209.
Pereira MFB, Litvinov N, Farhat SCL, et al. Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics (Sao Paulo). 2020;75:e2209.
Pereira, M. F. B., Litvinov, N., Farhat, S. C. L., Eisencraft, A. P., Gibelli, M. A. B. C., Carvalho, W. B., Fernandes, V. R., Fink, T. T., Framil, J. V. S., Galleti, K. V., Fante, A. L., Fonseca, M. F. M., Watanabe, A., Paula, C. S. Y., Palandri, G. G., Leal, G. N., Diniz, M. F. R., Pinho, J. R. R., Silva, C. A., ... Jorge, P. P. D. (2020). Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics (Sao Paulo, Brazil), 75, e2209. https://doi.org/10.6061/clinics/2020/e2209
Pereira MFB, et al. Severe Clinical Spectrum With High Mortality in Pediatric Patients With COVID-19 and Multisystem Inflammatory Syndrome. Clinics (Sao Paulo). 2020;75:e2209. PubMed PMID: 32844958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. AU - Pereira,Maria Fernanda Badue, AU - Litvinov,Nadia, AU - Farhat,Sylvia Costa Lima, AU - Eisencraft,Adriana Pasmanik, AU - Gibelli,Maria Augusta Bento Cicaroni, AU - Carvalho,Werther Brunow de, AU - Fernandes,Vinicius Rodrigues, AU - Fink,Thais de Toledo, AU - Framil,Juliana Valéria de Souza, AU - Galleti,Karine Vusberg, AU - Fante,Alice Lima, AU - Fonseca,Maria Fernanda Mota, AU - Watanabe,Andreia, AU - Paula,Camila Sanson Yoshino de, AU - Palandri,Giovanna Gavros, AU - Leal,Gabriela Nunes, AU - Diniz,Maria de Fatima Rodrigues, AU - Pinho,João Renato Rebello, AU - Silva,Clovis Artur, AU - Marques,Heloisa Helena de Sousa, AU - ,, AU - Rossi Junior,Alfio, AU - Delgado,Artur Figueiredo, AU - Andrade,Anarella Penha Meirelles de, AU - Schvartsman,Claudio, AU - Sabino,Ester Cerdeira, AU - Rocha,Mussya Cisotto, AU - Kanunfre,Kelly Aparecida, AU - Okay,Thelma Suely, AU - Carneiro-Sampaio,Magda Maria Sales, AU - Jorge,Patricia Palmeira Daenekas, Y1 - 2020/08/19/ PY - 2020/07/07/received PY - 2020/07/16/accepted PY - 2020/8/27/entrez PY - 2020/8/28/pubmed PY - 2020/9/8/medline SP - e2209 EP - e2209 JF - Clinics (Sao Paulo, Brazil) JO - Clinics (Sao Paulo) VL - 75 N2 - 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. SN - 1980-5322 UR - https://www.unboundmedicine.com/medline/citation/32844958/Severe_clinical_spectrum_with_high_mortality_in_pediatric_patients_with_COVID_19_and_multisystem_inflammatory_syndrome_ L2 - https://www.scielo.br/scielo.php?script=sci_arttext&amp;pid=S1807-59322020000100263&amp;lng=en&amp;nrm=iso&amp;tlng=en DB - PRIME DP - Unbound Medicine ER -