From the Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador.
Unidad de Cuidados Intensivos Pediátricos, Hospital Pediátrico Baca Ortiz, Quito, Ecuador.
Pediatr Infect Dis J. 2023 Apr 1;42(4):305-309. doi: 10.1097/INF.0000000000003811. Epub 2022 Dec 28.
Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C).
One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission.
Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities.
Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.
儿童多系统炎症综合征（MIS-C）与儿科重症监护病房中接受治疗的儿童中严重急性呼吸综合征冠状病毒 2 感染有关。我们旨在比较患有儿科急性呼吸窘迫综合征（PARDS）的患者与同时患有 MIS-C 诊断的患者（PARDS 与 PARDS+MIS-C）。
2020 年 6 月至 2021 年 6 月，厄瓜多尔基多一家国家参考儿童医院的儿科重症监护病房 COVID-19 病房收治了 167 名（0-15 岁）患有 PARDS 合并或不合并 MIS-C 的儿童。为了诊断 PARDS，使用了儿科急性肺损伤共识会议组的标准，为了诊断 MIS-C，使用了疾病控制与预防中心的标准。此外，还使用 PRISM 评分来计算入院时研究患者的死亡风险。
在 167 名患有 PARDS 的患者中，约 59%的患者同时患有 MIS-C。PARDS+MIS-C 患者的以下风险高于无 MIS-C 患者：合并细菌感染的频率（81.6% vs. 55.1%）、死亡风险（36.7% vs. 11.6%）、呼吸支持的使用（有创机械通气：92% vs. 86%）、血管加压素/正性肌力药物的使用（90.8% vs. 30.4%）、肾脏并发症（36.7% vs. 8.7%）、感染性休克（84.7% vs. 20.3%）、多器官衰竭（39.8% vs. 1.4%）和出院时的死亡率（39.8% vs. 4.3%）。逻辑回归未发现 MIS-C 与年龄、种族、性别、≥3 个症状/体征和≥2 种合并症之间存在关联。
PARDS+MIS-C 患者的临床症状比无 MIS-C 患者更严重。这些发现为改善厄瓜多尔患有和不患有 MIS-C 的 PARDS 患者的管理提供了有用的信息。
