Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020

Niño-Taravilla, Carmen; Otaola-Arca, Hugo; Lara-Aguilera, Natalie; Zuleta-Morales, Yuri; Ortiz-Fritz, Paula

doi:10.3201/eid2705.204591

Cited by 16 publications

(20 citation statements)

References 13 publications

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“…Similar to previous reports, 3 , 16 , 17 age and race strongly associate with severe MIS-C. Although children between the ages of 6–12 were more likely to develop MIS-C, the frequency of intensive care unit admission, inotropic support, and mechanical ventilation was higher in older children.…”

Section: Discussionsupporting

confidence: 88%

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Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study

Savorgnan

Moreira

et al. 2022

Pediatr Res

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Objective The purpose of this study was to describe the clinical presentation and physiologic profile of individuals with varying degrees of severity of multisystem inflammatory syndrome in children (MIS-C). Methods We performed a retrospective study of children diagnosed with MIS-C admitted to a single quaternary children’s hospital from May 2020 to April 2021. We created an MIS-C severity score using the following parameters: hospital admission status (e.g., floor vs intensive care unit), need for inotropic or vasoactive medications, and need for mechanical ventilation. Univariate and multivariate analyses were performed to associate risk factors corresponding to the MIS-C severity score. Results The study included 152 children who were followed for 14 days post hospital admission. A stepwise forward selection process identified seven physiologic variables associated with “severe” MIS-C according to a logistic regression. Specifically, a combination of elevated creatinine ( p = 0.013), international normalized ratio ( p = 0.002), brain natriuretic peptide ( p = 0.001), white blood cell count ( p = 0.009), ferritin ( p = 0.041), respiratory rate ( p = 0.047), and decreased albumin ( p = 0.047) led to an excellent discrimination between mild versus severe MIS-C (AUC = 0.915). Conclusion This study derived a physiologic profile associated with the stratification of MIS-C severity. Impact Based on a cohort of 152 individuals diagnosed with MIS-C, this study derived a nomenclature that stratifies the severity of MIS-C. Investigated demographic, presentational vital signs, and blood analytes associated with severity of illness. Identification of a multivariate physiologic profile that strongly associates with MIS-C severity. This model allows the care team to recognize patients likely to require a higher level of intensive care.

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Section: Discussionsupporting

confidence: 88%

“… 6 – 15 More recently, studies describe the clinical spectrum of MIS-C and the correlation of certain factors (e.g., demographics, laboratory markers) with disease severity. 3 , 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study

Savorgnan

Moreira

et al. 2022

Pediatr Res

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“…Few studies focus on pediatric critical COVID-19, and most larger studies are from high-income countries (HICs) [4][5][6][7] . Studies examining pediatric ICU (PICU) admissions from low-middle-income countries (LMICs) are scarce, and the main focus has been multisystem inflammatory syndrome in children (MIS-C) [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Pediatric critical COVID-19 and mortality in a multinational cohort

González‐Dambrauskas¹,

Vásquez‐Hoyos

Camporesi

et al. 2021

Preprint

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Objectives: To understand the international epidemiology of critical pediatric COVID-19 and compare presentation, treatments, and outcomes of younger (<2 years) and older (>2 years) children. Design: Prospective, observational study from April 1 to December 31, 2020 Setting: International multicenter study from 55 sites from North America, Latin America, and Europe. Participants: Patients <19 years old hospitalized with critical COVID-19 Interventions: none Main outcomes measured: Clinical course, treatments, and outcomes were compared between younger and older children. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) for hospital mortality. Results: 557 subjects (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Younger children had more respiratory findings (56% vs 44%), viral pneumonia (45% vs 29%), and treatment with invasive ventilation (50% vs 37). Gastrointestinal (28% vs 69%) or mucocutaneous (16% vs 44%) findings, vasopressor requirement (44% vs 60%), and MIS-C (15% vs 40%) were less common in younger children. Hospital mortality was 10% overall but 15% in younger children (odds ratio 1.89 [95%CI 1.05-3.39]). When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2.6; 95%CI 1.07-6.31) or pulmonary comorbidities (aOR 4.4; 95%CI 1.68-11.5), admission hypoxemia (aOR 2.33; 95%CI 1.24-4.37), and lower respiratory symptoms (aOR 2.83; 95%CI 1.49-5.39). Gastrointestinal (aOR 0.49; 95%CI 0.26-0.92) or mucocutaneous symptoms (aOR 0.31; 95%CI 0.15-0.64), treatment with intravenous immune globulin (aOR 0.33; 95%CI 0.17-0.65), and MIS-C (aOR 0.26; 95%CI 0.11-0.64) were associated with lower mortality. Conclusions: We identified age-related differences in presentation and mortality for critical pediatric COVID-19 that should prompt more attention to improving management in younger children, especially in developing countries.

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“…The conventional medical treatment for patients with MIS-C is based on the protocol used for KD, consisting of the administration of intravenous Ig with or without aspirin, corticosteroids, immunomodulatory agents such as infliximab (tumor necrosis factor-alpha neutralizer) 49,50 , tocilizumab (IL-6 signal transduction inhibitor) 51 , and anakinra (IL-1 receptor antagonist) [52][53][54][55] , which are effective in diseases with a similar systemic inflammatory load 56,57 . The use of early immunotherapy with tocilizumab in patients without cardiac complications or infliximab in patients with positive echocardiographic findings avoided the need for extracorporeal membrane support therapy, demonstrating that immunotherapy prevents further supportive interventions in patients with MIS-C 54 . However, clinical trials with a more extensive study population and study time are needed to elucidate the mechanisms of this therapy and its possible effects on survival [58][59][60] .…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome and COVID-19: a scoping review

Tuta-Quintero¹,

Martínez-Ayala²,

Mantilla-Beltrán³

et al. 2022

BMHIM

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Background: Multisystem inflammatory syndrome temporally associated with COVID-19 presents with similar symptomatology and therapeutic approach to Kawasaki disease in the pediatric population. Given the novelty of the disease and the growing scientific literature on the subject, it is relevant to collect and report available scientific information. This review aimed to explore the medical evidence on multisystem inflammatory syndrome temporally associated with COVID-19 in a population under 18 years of age. Methods: We conducted a scoping review using Scopus and PubMed, including observational (cohort, case-control, and cross-sectional) studies and case series. Results: Of the total articles reviewed as of April 10, 2021, 45 articles met eligibility criteria: case series (n = 32), retrospective cohort studies (n = 6), prospective cohort studies (n = 4), case-control studies (n = 2), and cross-sectional studies (n = 1). Gastrointestinal and respiratory symptoms and myocardial dysfunction are the most commonly reported. The most relevant paraclinical markers were lymphopenia, thrombocytopenia, and elevated D-dimer levels. Conclusions: The multisystem inflammatory syndrome temporally associated with COVID-19 presents a broad spectrum of signs and symptoms. Aneurysms of the coronary arteries and myocarditis are usually present in the acute phases of the disease. The early diagnosis led by a multidisciplinary group of pediatric intensivists, infectious disease specialists, cardiologists, and rheumatologists allows adequate and effective medical management.

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Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020

Cited by 16 publications

References 13 publications

Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study

Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study

Pediatric critical COVID-19 and mortality in a multinational cohort

Multisystem inflammatory syndrome and COVID-19: a scoping review

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