Tunçer Tunç, Varol Fatih
Department of Pediatrics, Division of Pediatric Cardiology, Saglik Bilimleri University Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, 34785 Istanbul, Turkey.
Department of Pediatrics, Division of Pediatric Intensive Care Unit, Saglik Bilimleri University Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, 34785 Istanbul, Turkey.
Children (Basel). 2022 Oct 27;9(11):1640. doi: 10.3390/children9111640.
Background: Multisystem inflammatory syndrome in children is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. The aim of this study was to display the role of therapeutic plasma exchange on cardiovascular outcomes in children with multisystem inflammatory syndrome. Methods: This study included children who met the diagnostic criteria for multisystem inflammatory syndrome and who were admitted to the intensive care unit. This is a prospective single-center study conducted between August 2020 and September 2021. Subjects had cardiac involvement which was defined as elevated troponin I, abnormal electrocardiographic and echocardiographic findings. Patients were followed by a pediatric cardiologist throughout the intensive care unit stay and after discharge for 12 months. Patients were divided into two groups which received therapeutic plasma exchange and which did not. Results: 38 children were included in this study. There were 16 patients in the no plasma exchange group and 22 patients in the plasma exchange group. The two groups were similar in age, sex, leucocyte, thrombocyte count, neutrophil percentage, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, alanine aminotransferase, albumin, ferritin, fibrinogen, D-dimer, IL-6, troponin I, number of electrocardiographic abnormalities and patients with mitral valve regurgitation detected at admission (p > 0.05). There was no significant difference between the two groups in terms of duration of normalization of electrocardiographic abnormalities and disappearance of mitral valve regurgitation (p > 0.05). Duration of normalization of troponin I (2, IQR 1−4, versus 5, IQR 3−9 days; p = 0.044) and length of hospital stay (7, IQR 6−10, versus 13, 8−20 days; p = 0.001) was longer in the plasma exchange group. Conclusions: We did not observe any significant improvement in children having undergone plasma exchange as compared to children who did not. On the opposite, their length of hospital stay and time to troponin I normalisation were even longer. Some baseline differences in cardiac attainment severity may partly explain this finding.
儿童多系统炎症综合征是新型冠状病毒2（SARS-CoV-2）感染后出现的一种新的、罕见的儿童感染后并发症。本研究旨在探讨治疗性血浆置换在儿童多系统炎症综合征心血管结局中的作用。方法：本研究纳入符合儿童多系统炎症综合征诊断标准且入住重症监护病房的儿童。这是一项于2020年8月至2021年9月进行的前瞻性单中心研究。受试者存在心脏受累，定义为肌钙蛋白I升高、心电图和超声心动图检查结果异常。在整个重症监护病房住院期间及出院后12个月，由儿科心脏病专家对患者进行随访。患者分为接受治疗性血浆置换组和未接受治疗性血浆置换组。结果：本研究共纳入38名儿童。未进行血浆置换组有16例患者，血浆置换组有22例患者。两组在年龄、性别、白细胞、血小板计数、中性粒细胞百分比、血红蛋白、C反应蛋白、红细胞沉降率、丙氨酸氨基转移酶、白蛋白、铁蛋白、纤维蛋白原、D-二聚体、白细胞介素-6、肌钙蛋白I、入院时检测到的心电图异常数量以及二尖瓣反流患者数量方面相似（p>0.05）。两组在心电图异常恢复正常的持续时间和二尖瓣反流消失方面无显著差异（p>0.05）。血浆置换组肌钙蛋白I恢复正常的持续时间（2天，四分位数间距1 - 4天，对比5天，四分位数间距3 - 9天；p = 0.044）和住院时间（7天，四分位数间距6 - 10天，对比13天，8 - 20天；p = 0.001）更长。结论：与未接受血浆置换的儿童相比，我们未观察到接受血浆置换的儿童有任何显著改善。相反，他们的住院时间和肌钙蛋白I恢复正常的时间甚至更长。心脏受累严重程度的一些基线差异可能部分解释了这一发现。
