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Liver and Pancreatic Involvement in Children with Multisystem Inflammatory Syndrome Related to SARS-CoV-2: A
Antonietta Giannattasio1, Marco Maglione1, Carolina D'Anna1
1Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, AORN, 80130 Naples, Italy.
Insights
Liver and pancreatic issues are common in children with Multisystem Inflammatory Syndrome (MIS-C) due to SARS-CoV-2. While often mild, these conditions require careful monitoring for potential complications and recovery.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Multisystem Inflammatory Syndrome related to SARS-CoV-2 (MIS-C) can affect various organs in children.
- Liver and pancreatic involvement in MIS-C is not well-understood.
- Understanding these complications is crucial for managing pediatric COVID-19 sequelae.
Purpose of the Study:
- To investigate the prevalence of acute liver injury (ALI) and pancreatic injury in children with MIS-C.
- To analyze the correlation between liver/pancreatic involvement and clinical outcomes in MIS-C patients.
- To describe the clinical, laboratory, and imaging features of affected children.
Main Methods:
- Prospective cohort study of 55 children diagnosed with MIS-C.
- Collection of demographic, clinical, laboratory, and imaging data at admission and during hospitalization.
- Analysis of acute liver injury (ALI) and pancreatic enzyme levels (lipase).
Main Results:
- At admission, 16 patients had ALI and 5 had elevated lipase; during observation, 10 more developed ALI and 19 more had elevated pancreatic enzymes.
- ALI was associated with older age (p=0.0004).
- Pancreatic involvement correlated with a longer hospital stay (p=0.004), and ALI onset was earlier than pancreatic enzyme elevation (p=0.035).
Conclusions:
- Liver and pancreatic involvement are frequently observed in pediatric MIS-C patients.
- These involvements are typically mild and associated with a complete recovery.
- Early identification and monitoring of hepatic and pancreatic changes are important in MIS-C management.
Abstract:
Liver and pancreatic involvement in children with Multisystem Inflammatory Syndrome related to SARS-CoV-2 (MIS-C) has been poorly investigated so far. We reviewed a cohort of MIS-C patients to analyze the prevalence of acute liver injury (ALI) and pancreatic injury and their correlation with clinical outcomes. Demographic, clinical, laboratory and imaging features of children with MIS-C at admission and during hospital stay were prospectively collected. Fifty-five patients (mean age 6.5 ± 3.7 years) were included. At admission, 16 patients showed ALI and 5 had increased total serum lipase. During observation, 10 more patients developed ALI and 19 more subjects presented raised pancreatic enzymes. In comparison to those with normal ALT, subjects with ALI were significantly older (p = 0.0004), whereas pancreatic involvement was associated to a longer duration of hospital stay compared with patients with normal pancreatic enzymes (p = 0.004). Time between hospital admission and onset of ALI was shorter compared to the onset of raised pancreatic enzymes (3.2 ± 3.9 versus 5.3 ± 2.7 days, respectively; p = 0.035). Abdominal ultrasound showed liver steatosis in 3/26 (12%) and hepatomegaly in 6/26 (16%) patients with ALI; 2 patients presented enlarged pancreas. Although liver and pancreatic involvement is commonly observed in MIS-C patients, it is mild in most cases with a complete recovery.
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