Division of Critical Care Medicine, Texas Children's Hospital, Houston, TX.
Division of Cardiology, Texas Children's Hospital, Houston, TX.
Pediatr Crit Care Med. 2022 Aug 1;23(8):e372-e381. doi: 10.1097/PCC.0000000000002976. Epub 2022 May 4.
To compare the clinical, laboratory, and hemodynamic parameters during hospitalization for patients with multisystem inflammatory syndrome in children (MIS-C), across the Original/Alpha and the Delta variants of severe acute respiratory syndrome coronavirus 2 infection.
Retrospective cohort study.
Single-center quaternary children's hospital.
Children with MIS-C admitted from May 2020 to February 2021(Original and Alpha variant cohort) and August 2021 to November 2021 (Delta variant cohort).
Continuous vital sign measurements, laboratory results, medications data, and hospital outcomes from all subjects were evaluated. Of the 134 patients (102 with Original/Alpha and 32 with Delta), median age was 9 years, 75 (56%) were male, and 61 (46%) were Hispanics. The cohort with Original/Alpha variant had more males (61% vs 41%; p = 0.036) and more respiratory/musculoskeletal symptoms on presentation compared with the Delta variant ( p < 0.05). More patients in the Original/Alpha variant cohort received mechanical ventilation (16 vs 0; p = 0.009). Median hospital length of stay (LOS) was 7 days, and ICU LOS was 3 days for the entire cohort. ICU LOS was shorter in cohort with the Delta variant compared with the Original/Alpha variant (4 vs 2 d; p = 0.001). Only one patient had cardiac arrest, two needed extracorporeal membrane oxygenation, and two needed left ventricular assist device (Impella, Danvers, MA), all in the Original/Alpha variant cohort; no mortality occurred in the entire cohort. MIS-C cohort associated with the Delta variant had lower INR, prothrombin time, WBCs, sodium, phosphorus, and potassium median values ( p < 0.05) during hospitalization compared with the Original/Alpha variants. Hemodynamic assessment showed significant tachycardia in the Original/Alpha variants cohort compared with the Delta variant cohort ( p < 0.05).
None.
Patients with MIS-C associated with the Delta variants had lower severity during hospitalization compared with the Original/Alpha variant. Analysis of distinct trends in clinical and laboratory parameters with future variants of concerns will allow for potential modification of treatment protocol.
比较儿童多系统炎症综合征（MIS-C）患者因严重急性呼吸综合征冠状病毒 2 感染的原始/阿尔法和德尔塔变异株住院期间的临床、实验室和血液动力学参数。
回顾性队列研究。
单中心四级儿童医院。
2020 年 5 月至 2021 年 2 月（原始和阿尔法变异株队列）和 2021 年 8 月至 2021 年 11 月（德尔塔变异株队列）期间因 MIS-C 住院的患儿。
评估所有患者的连续生命体征测量、实验室结果、药物数据和住院结局。在 134 例患者（102 例为原始/阿尔法，32 例为德尔塔）中，中位年龄为 9 岁，75 例（56%）为男性，61 例（46%）为西班牙裔。与德尔塔变异株相比，原始/阿尔法变异株的队列中男性更多（61% vs 41%；p=0.036），且就诊时呼吸/肌肉骨骼症状更多（p<0.05）。原始/阿尔法变异株组中更多的患者接受机械通气（16 例 vs 0 例；p=0.009）。整个队列的中位住院时间（ LOS ）为 7 天，ICU LOS 为 3 天。与原始/阿尔法变异株相比，德尔塔变异株组的 ICU LOS 更短（4 天 vs 2 天；p=0.001）。只有 1 例患者发生心脏骤停，2 例需要体外膜氧合，2 例需要左心室辅助装置（Impella，Danvers，MA），均在原始/阿尔法变异株组；整个队列均无死亡。与原始/阿尔法变异株相比，Delta 变异株相关的 MIS-C 患儿在住院期间的 INR、凝血酶原时间、白细胞计数、钠、磷和钾中位数均较低（p<0.05）。血液动力学评估显示，原始/阿尔法变异株组的心动过速明显高于德尔塔变异株组（p<0.05）。
无。
与原始/阿尔法变异株相比，Delta 变异株相关的 MIS-C 患儿在住院期间的严重程度较低。对未来关注变异株的临床和实验室参数的不同趋势进行分析，将有助于对治疗方案进行潜在调整。
