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Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory
Maria Fernanda Badue Pereira1, Nadia Litvinov1, Sylvia Costa Lima Farhat1
1Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Insights
Pediatric COVID-19 patients with multisystem inflammatory syndrome (MIS-C) experienced severe illness and higher mortality. Early investigation of MIS-C is crucial for COVID-19 cases with gastrointestinal symptoms and hypoxemia.
Area of Science:
- Pediatric infectious diseases
- Critical care medicine
- Public health
Background:
- Coronavirus disease (COVID-19) can present with severe outcomes in children.
- Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of COVID-19.
- Understanding the clinical spectrum and outcomes of pediatric COVID-19 with and without MIS-C is vital.
Purpose of the Study:
- To compare the clinical outcomes of pediatric patients with laboratory-confirmed COVID-19, with or without MIS-C.
- To identify risk factors and clinical characteristics associated with MIS-C in pediatric COVID-19 patients.
Main Methods:
- A cross-sectional study involving 371 pediatric patients (age < 18 years) with suspected SARS-CoV-2 infection.
- Laboratory confirmation of SARS-CoV-2 infection using RT-PCR or serological tests.
- Diagnosis of MIS-C based on CDC criteria.
Main Results:
- 9% of pediatric COVID-19 patients (6/66) were diagnosed with MIS-C.
- MIS-C patients showed significantly higher frequencies of gastrointestinal symptoms, hypoxemia, and elevated inflammatory markers (CRP, D-dimer).
- MIS-C was associated with increased rates of PICU admission, mechanical ventilation, shock, cardiac abnormalities, and mortality.
Conclusions:
- Pediatric COVID-19 patients with MIS-C exhibit a severe clinical course and high mortality rate.
- Gastrointestinal manifestations and hypoxemia are significant indicators for investigating MIS-C in pediatric COVID-19.
- Prompt recognition and management of MIS-C are critical for improving outcomes in pediatric COVID-19.
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.
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