Risk factors of a severe course of pediatric multi-system inflammatory syndrome temporally associated with COVID-19

Abstract

Pediatric multi-system inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) is a serious complication of a previous SARS-CoV-2 infection. The disease causes multiple organ failure, but in some patients, a more severe course of the disease is observed. The treatment is multidirectional and depends on the severity and course of the disease, as some patients do not respond to the recommended treatment. The aim of this study was to identify laboratory risk factors affecting the more severe course of the disease and resistance to standard therapy. It is a single-center retrospective study considering 51 patients with PIMS-TS. Clinical features, laboratory results, and additional imaging tests data were taken into account. Fifty-one patients with PIMS-TS were hospitalized within a 16-month observation period. In the studied group, 26/51 children (51%) were girls. The mean age of patients was 7 years. Sex of the patient was not a risk factor for changes in cardiovascular system or severe course of the disease. Sixteen patients (31.3%) required transfer to the intensive care unit. Children with initially higher concentrations of NT-proBNP, troponin, creatinine, triglycerides, C-reactive protein, procalcitonin, ferritin, D-dimers and lower hematocrit, platelet count, lymphocytes, and ejection fraction should be strictly observed as they have a higher risk of severe course of the disease.Conclusions: Laboratory parameters especially markers of myocardial damage, markers of inflammation, blood count, as wells as biochemical parameters are significant risk indicators of severe course of PIMS -TS and their concentration can be defined as predictor of disease severity. What is Known:• Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) is a serious complication of a previous SARS-CoV-2 infection in the group of pediatric patients• Course of the disease may be severe, which may cause long-term complications and the need for longitudinal patient care. What is New:• Children with higher concentrations of NT-proBNP, troponin, creatinine, TG, CRP, PCT, ferritin, D-dimers and lower hematocrit, PLT, lymphocytes, and EF have a higher risk of a severe course of the disease.• Patients with high concentration of NT-proBNP, troponin, CRP, lactates, ferritin, D-dimers, creatinine and a lower concentration of PLT, albumin, leukocytes; lymphopenia, hyponatremia are at risk for intravenous immunoglobulin resistance.

“Multisystem Inflammatory Syndrome in Children”-Like Disease after COVID-19 Vaccination (MIS-V) with Potential Significance of Functional Active Autoantibodies Targeting G-Protein-Coupled Receptors (GPCR-fAAb) for Pathophysiology and Therapy

“…SARS-CoV-2 predominantly causes symptoms of the respiratory tract but also may affect multiple organ systems, which can lead to various, and in some cases severe, symptoms, including organ failure [19][20][21][22][23][24]. A certain type of this systemic disease in children is known under the name of MIS-C [25][26][27][28]. In a systematic review and meta-analysis, Santos et al described the most prevalent symptoms of MIS-C as fever and gastrointestinal symptoms including abdominal pain, skin manifestations and non-purulent conjunctivitis.…”

PIMS - symptoms and short/long-term gastrointestinal and cardiovascular system complications

“…Częstość występowania PIMS koreluje z zachorowalnością na COVID-19 w danym czasie i regionie. [1] KRYTERIA ROZPOZNANIA PIMS W celu postawienia rozpoznania PIMS opracowano 6 kryteriów takich jak: 1) wiek 0-18 lat, 2) gorączka >38,5C utrzymująca się minimum 3 dni [1], 3) nieprawidłowe wyniki laboratoryjne (podwyższone NT-proBNP, troponina, kreatynina, trójglicerydy, CRP, PCT, ferrytyna, D-dimery; obniżony hematokryt, PLT, limfocyty oraz EF) [12], 4) uszkodzenie wielonarządowe -dysfunkcja co najmniej 2 narządów lub układów, 5) wykluczenie innych przyczyn (posocznica, zespół wstrząsu toksycznego, ostra choroba wirusowa, ostre zapalenie wyrostka robaczkowego i otrzewnej, choroby układowe tkanki łącznej, choroby rozrostowe, nieswoiste zapalenia jelit) [1], 6) stwierdzenie powiązania z wirusem SARS-CoV-2 : dodatni wynik RT-PCR, dodatni wynik testu antygenowego, obecność przeciwciał lub ekspozycja na COVID-19 w poprzednich 4-8 tygodniach (kryterium nie obligatoryjne). [1] POWIKŁANIA Z UKŁADU POKARMOWEGO Jednymi z pierwszych i głównych manifestacji PIMS, zaraz po notowanej gorączce są objawy związane z układem pokarmowym, obecne u ok.80% przypadków [6].…”

“…Dawka jest zależna od statusu hemodynamicznego, LVEF i objawów KD (1-2g/kg/dzień -max.70g/dzień) [6]. Pacjenci z wysokimi stężeniami NT-proBNP, troponiny, CRP, mleczanów, ferrytyny, D-dimerów, kreatyniny i niższymi stężeniami PLT, albumin, leukocytów, limfopenią i hiponatremią są narażeni na ryzyko wystąpienia oporności na immunoglobuliny podawane dożylnie [12]. Ponowny, drugi wlew z IVIG u chorych niereagujących na leczenie I rzutu nie jest zalecany [1].…”

Nutraceuticals for Complementary Treatment of Multisystem Inflammatory Syndrome in Children: A Perspective from Their Use in COVID-19

“…In the acute phase of MIS-C, exacerbation of cytokines as some interleukins (IL), tumor necrosis factor-alpha (TNF-a), and interferon-gamma (INF-γ) levels have been reported [ 48 , 51 , 52 , 53 , 54 , 55 ], as well as chemokines including the IL-2 receptor agonist, C-C motif chemokine ligand 2 (CCL2), C-X-C motif chemokine ligands 8, 9 and 10 (CXCL8, CXCL9, CXCL10), and monocyte chemoattractant protein (MCP)-1 [ 42 , 48 , 56 , 57 , 58 ]. In addition, changes in leukocyte count and distribution are considered as circulating biomarkers [ 54 , 59 , 60 , 61 , 62 ], as well as significant changes in serum biomarkers such as albumin [ 26 , 44 , 63 , 64 ], lactate dehydrogenase (LDH) [ 41 ], creatinine [ 41 , 48 ], sodium [ 48 , 57 , 63 ], triglycerides [ 65 , 66 ] and zonulin [ 67 , 68 ] ( Table 1 ).…”