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Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature.
J Intensive Care Med. 2021 Apr; 36(4):392-403.JI

Abstract

BACKGROUND

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease.

OBJECTIVE

To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided.

METHODS

Retrospective case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock.

RESULTS

Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died.

CONCLUSION

Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.

Authors+Show Affiliations

Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Department of Pediatric Cardiology, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33148089

Citation

Caro-Patón, Gema de Lama, et al. "Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: what We Know. Case Series and Review of the Literature." Journal of Intensive Care Medicine, vol. 36, no. 4, 2021, pp. 392-403.
Caro-Patón GL, de Azagra-Garde AM, García-Salido A, et al. Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature. J Intensive Care Med. 2021;36(4):392-403.
Caro-Patón, G. L., de Azagra-Garde, A. M., García-Salido, A., Cabrero-Hernández, M., Tamariz, A., & Nieto-Moro, M. (2021). Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature. Journal of Intensive Care Medicine, 36(4), 392-403. https://doi.org/10.1177/0885066620969350
Caro-Patón GL, et al. Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: what We Know. Case Series and Review of the Literature. J Intensive Care Med. 2021;36(4):392-403. PubMed PMID: 33148089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature. AU - Caro-Patón,Gema de Lama, AU - de Azagra-Garde,Amelia Martínez, AU - García-Salido,Alberto, AU - Cabrero-Hernández,Marta, AU - Tamariz,Amalia, AU - Nieto-Moro,Montserrat, Y1 - 2020/11/05/ PY - 2020/11/6/pubmed PY - 2021/3/16/medline PY - 2020/11/5/entrez KW - COVID-19 KW - children KW - inflammation KW - multisystem inflammatory syndrome KW - myocardial injury KW - pediatric intensive care KW - shock SP - 392 EP - 403 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 36 IS - 4 N2 - BACKGROUND: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease. OBJECTIVE: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. METHODS: Retrospective case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock. RESULTS: Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died. CONCLUSION: Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/33148089/Shock_and_Myocardial_Injury_in_Children_With_Multisystem_Inflammatory_Syndrome_Associated_With_SARS_CoV_2_Infection:_What_We_Know__Case_Series_and_Review_of_the_Literature_ L2 - https://journals.sagepub.com/doi/10.1177/0885066620969350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -