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Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (MIS-C)-Characteristics and Prognostic
Anna Camporesi1, Marco Gemma2, Danilo Buonsenso3
1Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", 20154 Milano, Italy.
Insights
Lung Ultrasound (LUS) can predict Multisystem Inflammatory Syndrome in Children (MIS-C) severity. Specific LUS patterns, like subpleural consolidations, indicate a higher risk of severe illness and need for intensive care.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Infectious diseases
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a hyperinflammatory condition post-COVID-19.
- Limited data exists on Lung Ultrasound (LUS) findings in pediatric MIS-C.
- LUS may offer a valuable, non-invasive imaging tool for assessing disease severity.
Purpose of the Study:
- To describe Lung Ultrasound (LUS) patterns in pediatric patients diagnosed with MIS-C.
- To correlate LUS findings with clinical indicators of illness severity.
- To assess the concordance between LUS and Chest X-ray (CXR) in MIS-C.
Main Methods:
- Retrospective observational study of 24 pediatric patients (0-18 years) with MIS-C.
- Analysis of clinical, laboratory, LUS, and CXR data at admission.
- Outcomes included PICU admission, respiratory support, inotrope use, and length of stay.
Main Results:
- Subpleural consolidations (> or < 1 cm) with or without pleural effusion on LUS correlated with reduced Left Ventricular Ejection Fraction and need for inotropes.
- Smaller subpleural consolidations (< 1 cm) were associated with longer Pediatric Intensive Care Unit (PICU) stays.
- Agreement between LUS and CXR for consolidations and effusions was found to be slight.
Conclusions:
- Specific LUS patterns, particularly subpleural consolidations, are significant predictors of MIS-C severity.
- LUS can be utilized at admission to effectively stratify the risk of severe disease in pediatric MIS-C patients.
- Lung Ultrasound demonstrates potential as a crucial tool for early risk assessment in MIS-C.
Abstract:
Objective and design: Following COVID-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described, but data describing the LUS findings of MIS-C are limited. The aim of this retrospective observational study conducted between 1 March and 31 December 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. The secondary objective is to evaluate concordance of LUS with Chest X-ray (CXR). Methodology: Clinical and laboratory data were collected for all patients (age 0−18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, needed for respiratory support and inotrope administration, hospital, and PICU length of stay, were considered as outcomes and evaluated in the different LUS patterns. An agreement between LUS and CXR evaluation was assessed with Cohen’ k. Results: 24 children, who had a LUS examination upon admission, were enrolled. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. Conclusion: LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity; under this aspect, LUS can be used at admission to stratify risk of severe disease.
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