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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.
Crit Care. 2020 11 26; 24(1):666.CC

Abstract

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.

Authors+Show Affiliations

Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Hospital Universitario Son Espases, Palma, Spain.Hospital Universitario 12 de Octubre, Madrid, Spain.Hospital Universitario Vall D'Hebron, Barcelona, Spain.Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain.Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Hospital Regional Universitario de Málaga, Málaga, Spain.Hospital Universitario Sant Joan de Deu, Esplugues de Llobregat, Spain.Hospital Universitario de Burgos, Burgos, Spain.Hospital Universitario Virgen de La Salud, Toledo, Spain.Hospital Universitario Ramón Y Cajal, Madrid, Spain.Clínica Universidad de Navarra, Pamplona, Spain.Complejo Asistencial Universitario de León, León, Spain.Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.Hospital General Universitario de Albacete, Albacete, Spain.Hospital General Universitario de Alicante, Alicante, Spain.Hospital Universitario Marques de Valdecilla, Santander, Spain.Hospital Universitario de Cruces, Barakaldo, Spain.Hospital Universitario Joan XXIII, Tarragona, Spain.Hospital Universitario Puerta del Mar, Cádiz, Spain.Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Spain.Hospital Universitario Virgen del Rocío, Sevilla, Spain.Hospital Universitario Virgen de La Macarena, Sevilla, Spain.Parc Tauli Hospital Universitari, Sabadell, Spain.Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain.Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain. rafa_gonzalez_cortes@hotmail.com.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33243303

Citation

García-Salido, Alberto, et al. "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." Critical Care (London, England), vol. 24, no. 1, 2020, p. 666.
García-Salido A, de Carlos Vicente JC, Belda Hofheinz S, et al. 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. Crit Care. 2020;24(1):666.
García-Salido, A., de Carlos Vicente, J. C., Belda Hofheinz, S., Balcells Ramírez, J., Slöcker Barrio, M., Leóz Gordillo, I., Hernández Yuste, A., Guitart Pardellans, C., Cuervas-Mons Tejedor, M., Huidobro Labarga, B., Vázquez Martínez, J. L., Gutiérrez Jimeno, M., Oulego-Erróz, I., Trastoy Quintela, J., Medina Monzón, C., Medina Ramos, L., Holanda Peña, M. S., Gil-Antón, J., Sorribes Ortí, C., ... González Cortés, R. (2020). 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. Critical Care (London, England), 24(1), 666. https://doi.org/10.1186/s13054-020-03332-4
García-Salido A, et al. 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. Crit Care. 2020 11 26;24(1):666. PubMed PMID: 33243303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - García-Salido,Alberto, AU - de Carlos Vicente,Juan Carlos, AU - Belda Hofheinz,Sylvia, AU - Balcells Ramírez,Joan, AU - Slöcker Barrio,María, AU - Leóz Gordillo,Inés, AU - Hernández Yuste,Alexandra, AU - Guitart Pardellans,Carmina, AU - Cuervas-Mons Tejedor,Maite, AU - Huidobro Labarga,Beatriz, AU - Vázquez Martínez,José Luís, AU - Gutiérrez Jimeno,Míriam, AU - Oulego-Erróz,Ignacio, AU - Trastoy Quintela,Javier, AU - Medina Monzón,Carmen, AU - Medina Ramos,Laura, AU - Holanda Peña,María Soledad, AU - Gil-Antón,Javier, AU - Sorribes Ortí,Clara, AU - Flores González,José Carlos, AU - Hernández Palomo,Rosa María, AU - Sánchez Ganfornina,Inma, AU - Fernández Romero,Emilia, AU - García-Besteiro,María, AU - López-Herce Cid,Jesús, AU - González Cortés,Rafael, AU - ,, Y1 - 2020/11/26/ PY - 2020/07/30/received PY - 2020/10/06/accepted PY - 2020/11/27/entrez PY - 2020/11/28/pubmed PY - 2020/11/28/medline KW - Children KW - Critical care KW - Kawasaki disease KW - Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 KW - SARS-CoV-2 KW - Shock KW - Toxic shock syndrome SP - 666 EP - 666 JF - Critical care (London, England) JO - Crit Care VL - 24 IS - 1 N2 - 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. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/33243303/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_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03332-4 DB - PRIME DP - Unbound Medicine ER -