Morparia Kavita, Spinella Philip C, McQueen Derrick, Kalyanaraman Meena, Bergel Maria, Lin John, Narang Shalu, Saini Arun
Pediatric Critical Care Medicine, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
Pediatric Critical Care Medicine, Department of Pediatrics, Washington School of Medicine in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri, USA.
Pediatr Blood Cancer. 2022 May;69(5):e29426. doi: 10.1002/pbc.29426. Epub 2021 Dec 22.
To describe critically ill children's coagulation profile with the multisystem inflammatory syndrome (MIS-C) related to coronavirus.
Single-center, observational study at a tertiary, pediatric intensive care unit (PICU) in children aged 1 month to 18 years.
Sixteen children, with a median age of 5.4 years (interquartile range [IQR] 2.1, 11.75), 56% female, admission Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score of 3.5 (IQR 2, 5), and median PICU length of stay 3 days (IQR 1.5, 4), met criteria of MIS-C. All patients received acetylsalicylic acid (80-100 mg/kg) and none received anticoagulation. Sixty-three percent (10/16) of children had out-of-normal range values on thromboelastography (TEG) (44% [7/16] with hypercoagulability and 19% [3/16] with hypocoagulability). Of those with hypercoagulability, 19% (3/16) had rapid clot formation, and 25% (4/16) had increased clot strength. In 69% (11/16) of children, there was impaired fibrinolysis (0% lysis at 30 minutes) on TEG. Seventy-five percent (12/16) of children had out-of-normal range value on standard coagulation assays (37.5% [6/16] with hypocoagulability and 37.5% [6/16] with hypercoagulability). TEG-G (clot strength as measured by TEG) value (ρ -.553, p = .033) and platelet count (ρ -.840, p < .0001) were correlated with admission PELOD-2 score. TEG-G value (ρ -.506, p = .04) and platelet count (ρ -.539, p = .03) were correlated with the duration of intensive care unit stay.
Coagulation abnormalities are frequent in children with MIS-C. TEG parameter and platelet count are correlated with the severity of multiorgan dysfunction and the duration of intensive care stay. Multicenter studies are needed to confirm the clinical implications of these coagulation abnormalities.
描述与冠状病毒相关的多系统炎症综合征（MIS-C）患儿的凝血情况。
在一家三级儿科重症监护病房（PICU）对1个月至18岁儿童进行的单中心观察性研究。
16名儿童符合MIS-C标准，中位年龄5.4岁（四分位间距[IQR]2.1，11.75），56%为女性，入院时儿科逻辑器官功能障碍评分-2（PELOD-2）为3.5（IQR 2，5），在PICU的中位住院时间为3天（IQR 1.5，4）。所有患者均接受了阿司匹林（80 - 100mg/kg）治疗，无一接受抗凝治疗。63%（10/16）的儿童血栓弹力图（TEG）值超出正常范围（44%[7/16]为高凝状态，19%[3/16]为低凝状态）。在高凝状态的儿童中，19%（3/16）凝血形成迅速，25%（4/16）凝血强度增加。69%（11/16）的儿童TEG显示纤溶功能受损（30分钟时0%溶解）。75%（12/16）的儿童标准凝血检测值超出正常范围（37.5%[6/16]为低凝状态，37.5%[6/16]为高凝状态）。TEG-G（TEG测量的凝血强度）值（ρ = -0.553，p = 0.033）和血小板计数（ρ = -0.840，p < 0.0001）与入院时的PELOD-2评分相关。TEG-G值（ρ = -0.506，p = 0.04）和血小板计数（ρ = -0.539，p = 0.03）与重症监护病房住院时间相关。
MIS-C患儿凝血异常常见。TEG参数和血小板计数与多器官功能障碍的严重程度及重症监护住院时间相关。需要多中心研究来证实这些凝血异常的临床意义。
