Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey.
Department of Pediatric Intensive Care, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey.
Clin Rheumatol. 2021 Oct;40(10):4167-4178. doi: 10.1007/s10067-021-05780-x. Epub 2021 Jun 5.
Multi-system inflammatory syndrome in children (MIS-C) is a less understood and a rare complication of coronavirus disease-2019 (COVID-19). Given the scarce data regarding this novel disease, we aimed to describe the clinical features and outcomes of our patients with MIS-C and to evaluate the associated factors for the pediatric intensive care unit (PICU) admission.
The MIS-C patients under 18 years old diagnosed and treated in three referral centers between July 2020 and March 2021 were included. Data of the patients were retrospectively obtained from their medical records.
Overall, 76 subjects (24 females) with a mean age of 8.17 ± 4.42 years were enrolled. Twenty-seven (35.5%) patients were admitted to the PICUs. The two most common systemic involvement patterns were cardiac and gastrointestinal. There was only one lethal outcome in a patient with underlying acute lymphoblastic leukemia. Those with higher procalcitonin levels at admission were found to stay longer in the hospital (r = 0.254, p = 0.027). The risk of PICU admission increased with age (aOR: 1.277; 95% CI: 1.089-1.498; p = 0.003) and with decreased initial serum albumin levels (aOR: 0.105; 95% CI: 0.029-0.378; p = 0.001).
Although there is a wide clinical variability among the patients with MIS-C, we suggest that those with older age and lower initial serum albumin levels merit close monitoring due to their higher risk for PICU admission. Key Points • Although there is a wide variability regarding the management process among clinicians, MIS-C is a rare, severe, less understood complication of COVID-19 that may cause rapid clinical deterioration in the patients. • Clinicians should be aware of this condition in children with persistent fever and a family history of COVID-19. • Older age and low serum albumin levels are the independent predictors for the pediatric intensive care unit admission among MIS-C patients.
儿童多系统炎症综合征（MIS-C）是 2019 年冠状病毒病（COVID-19）的一种较少被理解和罕见的并发症。鉴于关于这种新型疾病的数据稀缺，我们旨在描述我们的 MIS-C 患者的临床特征和结局，并评估小儿重症监护病房（PICU）入院的相关因素。
本研究纳入了 2020 年 7 月至 2021 年 3 月期间在三个转诊中心诊断和治疗的年龄在 18 岁以下的 MIS-C 患者。从他们的病历中回顾性获得患者的数据。
共有 76 名（24 名女性）平均年龄为 8.17±4.42 岁的患者入组。27 名（35.5%）患者被收治于 PICU。最常见的两种全身性受累模式是心脏和胃肠道。唯一的死亡病例发生在一名患有急性淋巴细胞白血病的患者。入院时降钙素水平较高的患者住院时间较长（r=0.254，p=0.027）。PICU 入院风险随年龄增加（aOR：1.277；95%CI：1.089-1.498；p=0.003）和初始血清白蛋白水平降低而增加（aOR：0.105；95%CI：0.029-0.378；p=0.001）。
尽管 MIS-C 患者的临床表现差异很大，但我们建议年龄较大和初始血清白蛋白水平较低的患者需要密切监测，因为他们 PICU 入院的风险较高。关键点•尽管临床医生在管理过程中有很大的变异性，但 MIS-C 是 COVID-19 的一种罕见、严重、较少被理解的并发症，可能导致患者病情迅速恶化。•临床医生应注意患有持续性发热和 COVID-19 家族史的儿童出现这种情况。•年龄较大和低血清白蛋白水平是 MIS-C 患者 PICU 入院的独立预测因素。
