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Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19:
Eliana M Legarda1,2, Jenny Martínez2, Ivan Sisa3
1From the Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador.
Insights
Children with pediatric acute respiratory distress syndrome (PARDS) who also have multisystem inflammatory syndrome (MIS-C) face a more severe clinical picture. This highlights the need for improved management strategies for these critically ill pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric intensive care
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is linked to SARS-CoV-2 infection in pediatric intensive care units.
- Pediatric acute respiratory distress syndrome (PARDS) is a critical respiratory condition in children.
Purpose of the Study:
- To compare clinical outcomes and characteristics of pediatric patients with PARDS, with and without a concurrent MIS-C diagnosis.
- To identify differences in severity and complications between PARDS and PARDS + MIS-C groups.
Main Methods:
- A retrospective study of 167 children (0-15 years) with PARDS admitted to a pediatric intensive care unit in Ecuador (June 2020-June 2021).
- Diagnosis of PARDS followed the Pediatric Acute Lung Injury Consensus Conference criteria.
- Diagnosis of MIS-C followed CDC criteria; PRISM score assessed mortality risk.
Main Results:
- Approximately 59% of PARDS patients also had MIS-C.
- PARDS + MIS-C patients exhibited significantly higher rates of bacterial infections, mortality risk, need for respiratory and vasopressor support, renal complications, septic shock, and multiorgan failure.
- Logistic regression did not associate MIS-C with age, race, sex, symptom count, or comorbidity count.
Conclusions:
- Patients with PARDS and MIS-C present a more severe clinical condition compared to those with PARDS alone.
- Findings offer valuable insights for optimizing the management of PARDS patients, with or without MIS-C, in Ecuador.
Background:
Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C).
Methods:
One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission.
Results:
Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities.
Conclusions:
Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.
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