Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Illinois, OSF St Francis Medical Centre at Peoria, Peoria, IL.
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.
Pediatr Crit Care Med. 2021 Jul 1;22(7):603-615. doi: 10.1097/PCC.0000000000002760.
To compare clinical characteristics and outcomes of children admitted to the PICU for severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. The secondary objective was to identify explanatory factors associated with outcome of critical illness defined by a composite index of in-hospital mortality and organ system support requirement.
Retrospective cohort study.
Thirty-eight PICUs within the Viral Infection and Respiratory Illness Universal Study registry from March 2020 to January 2021.
Children less than 18 years with severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children.
Of 394 patients, 171 (43.4%) had multisystem inflammatory syndrome in children. Children with multisystem inflammatory syndrome in children were more likely younger (2-12 yr vs adolescents; p < 0.01), Black (35.6% vs 21.9%; p < 0.01), present with fever/abdominal pain than cough/dyspnea (p < 0.01), and less likely to have comorbidities (33.3% vs 61.9%; p < 0.01) compared with those without multisystem inflammatory syndrome in children. Inflammatory marker levels, use of inotropes/vasopressors, corticosteroids, and anticoagulants were higher in multisystem inflammatory syndrome in children patients (p < 0.01). Overall mortality was 3.8% (15/394), with no difference in the two groups. Diagnosis of multisystem inflammatory syndrome in children was associated with longer duration of hospitalization as compared to nonmultisystem inflammatory syndrome in children (7.5 d[interquartile range, 5-11] vs 5.3 d [interquartile range, 3-11 d]; p < 0.01). Critical illness occurred in 164 patients (41.6%) and was more common in patients with multisystem inflammatory syndrome in children compared with those without (55.6% vs 30.9%; p < 0.01). Multivariable analysis failed to show an association between critical illness and age, race, sex, greater than or equal to three signs and symptoms, or greater than or equal to two comorbidities among the multisystem inflammatory syndrome in children cohort. Among nonmultisystem inflammatory syndrome in children patients, the presence of greater than or equal to two comorbidities was associated with greater odds of critical illness (odds ratio 2.95 [95% CI, 1.61-5.40]; p < 0.01).
This study delineates significant clinically relevant differences in presentation, explanatory factors, and outcomes among children admitted to PICU with severe acute respiratory syndrome coronavirus 2-related illness stratified by multisystem inflammatory syndrome in children.
比较因严重急性呼吸综合征冠状病毒 2 相关疾病而入住儿科重症监护病房（PICU）的儿童中伴有和不伴有儿童多系统炎症综合征（Multisystem Inflammatory Syndrome in Children，MIS-C）的临床特征和结局。次要目的是确定与以住院死亡率和器官系统支持需求的综合指数定义的危重症结局相关的解释因素。
回顾性队列研究。
2020 年 3 月至 2021 年 1 月期间，病毒感染和呼吸道疾病综合研究登记处的 38 个 PICU。
年龄小于 18 岁，因严重急性呼吸综合征冠状病毒 2 相关疾病而入住 PICU 的儿童，伴有或不伴有儿童多系统炎症综合征。
394 例患者中，171 例（43.4%）患有儿童多系统炎症综合征。与无儿童多系统炎症综合征的患者相比，患有儿童多系统炎症综合征的患者更可能年龄较小（2-12 岁与青少年；p<0.01）、为黑人（35.6%与 21.9%；p<0.01）、以发热/腹痛而非咳嗽/呼吸困难为首发症状（p<0.01），且合并症更少（33.3%与 61.9%；p<0.01）。与无儿童多系统炎症综合征的患者相比，儿童多系统炎症综合征患者的炎症标志物水平、使用血管活性药物/血管加压素、皮质类固醇和抗凝剂的比例更高（p<0.01）。总死亡率为 3.8%（15/394），两组间无差异。与非儿童多系统炎症综合征患者相比，儿童多系统炎症综合征的诊断与更长的住院时间相关（7.5 天[四分位距，5-11]与 5.3 天[四分位距，3-11 天]；p<0.01）。164 例（41.6%）患者发生危重症，儿童多系统炎症综合征患者比无儿童多系统炎症综合征患者更常见（55.6%与 30.9%；p<0.01）。多变量分析未能显示在儿童多系统炎症综合征队列中，危重症与年龄、种族、性别、≥3 种体征和症状或≥2 种合并症之间存在关联。在非儿童多系统炎症综合征患者中，存在≥2 种合并症与发生危重症的可能性更大相关（比值比 2.95[95%置信区间，1.61-5.40]；p<0.01）。
本研究描绘了因严重急性呼吸综合征冠状病毒 2 相关疾病而入住 PICU 的儿童中，根据儿童多系统炎症综合征的分层，在临床表现、解释因素和结局方面存在显著的临床相关差异。
