Klinik für Neonatologie und Allgemeine Pädiatrie, Klinikum Kassel, Gesundheit Nordhessen, Kassel, Mönchebergstr. 41-43, 34125 Kassel, Germany.
Klinik für Pädiatrische Kardiologie und Intensivmedizin, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
Cardiol Young. 2023 Apr;33(4):546-550. doi: 10.1017/S1047951122001251. Epub 2022 May 12.
In the absence of randomised trials for paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV2 (PIMS-TS), optimal management of PIMS-TS-patients remains somewhat uncertain. We aimed to evaluate the practicability of consensus diagnostic/therapeutic pathways in a real-life German hospital setting.
All children treated for PIMS-TS (February to November, 2021) at the Childrens' Hospital Kassel were analysed retrospectively. Patients were treated according to local PIMS-TS standardised operating procedure based on the Swiss and UK consensus statements.
Eleven patients treated for PIMS-TS were included in this study (female:male = 2.1:1). According to the categories of the Swiss and UK consensus statements, 36% were uncomplicated hyperinflammation, 36% Kawasaki-like and 27% shock-like disease. Local estimated incidence was 0.92/1000 Covid-19 cases in children aged 4-15 years. Significant inter-group differences in laboratory parameters were found: BNP was highest in shock-like presentation compared to Kawasaki-like and uncomplicated hyperinflammation (median 954 (668-1491) versus 213 (173-934) versus 80 (5-257) ng/l, p = 0.02), whereas troponin was highest in Kawasaki-like, followed by shock-like presentation and uncomplicated hyperinflammation (median 34.7 (27.5-58.4) versus 19.1 (14.1-23.4) versus 1.9 (1.9-16.4) ng/l, p = 0.02). Patients with shock-like presentation needed circulatory resuscitation in the paediatric ICU. All patients received standardised operating procedure-based therapy and were discharged home after a medium of 7.4 days.
The Swiss and UK consensus statements on the management of PIMS-TS proved very valuable in a real-life clinical setting, facilitated early categorisation, and initiation of specific therapy, possibly improving the outcome. Additional randomised trials are necessary to further improve the management of PIMS-TS.
由于缺乏与 SARS-CoV2 相关的儿科多系统炎症综合征（PIMS-TS）的随机试验，因此 PIMS-TS 患者的最佳治疗方法仍有些不确定。我们旨在评估在德国一家医院的真实环境中使用共识诊断/治疗途径的可行性。
回顾性分析 2021 年 2 月至 11 月在卡塞尔儿童医院接受 PIMS-TS 治疗的所有儿童。根据当地的 PIMS-TS 标准化操作程序，根据瑞士和英国的共识声明对患者进行治疗。
本研究纳入了 11 名接受 PIMS-TS 治疗的患者（女性：男性=2.1：1）。根据瑞士和英国共识声明的类别，36%为单纯性过度炎症，36%为川崎病样疾病，27%为休克样疾病。当地估计发病率为 4-15 岁儿童每 1000 例 COVID-19 病例中有 0.92 例。在实验室参数方面发现了显著的组间差异：休克样表现的 BNP 最高，与川崎病样和单纯性过度炎症相比（中位数 954（668-1491）比 213（173-934）比 80（5-257）ng/l，p=0.02），而肌钙蛋白在川崎病样疾病中最高，其次是休克样表现和单纯性过度炎症（中位数 34.7（27.5-58.4）比 19.1（14.1-23.4）比 1.9（1.9-16.4）ng/l，p=0.02）。休克样表现的患者需要在儿科 ICU 进行循环复苏。所有患者均接受基于标准化操作程序的治疗，并在平均 7.4 天后出院回家。
在真实的临床环境中，瑞士和英国关于 PIMS-TS 管理的共识声明非常有价值，有助于早期分类和启动特定治疗，可能改善预后。需要进一步的随机试验来进一步改善 PIMS-TS 的管理。
