Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom.
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Pediatr Allergy Immunol Pulmonol. 2023 Sep;36(3):94-103. doi: 10.1089/ped.2023.0024. Epub 2023 Jul 11.
Pediatric inflammatory multisystem syndrome temporarily associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PIMS-TS) is an acute complication of previous SARS-CoV-2 exposure. The relationship between inflammatory markers and anti-inflammatory medication in PIMS-TS is unknown. We retrospectively investigated the relationship between demographics, biomarkers, treatment, and length of stay (LOS) in this novel disease. We reviewed the case notes and blood tests of all patients who met the Royal College of Paediatrics and Child Health diagnostic criteria for PIMS-TS at a large tertiary center in the United Kingdom. Biomarker trajectories were modeled using log linear mixed effects, and factors affecting LOS in hospital were evaluated using multiple regression. Between March 2020 and May 2022, a total of 56 patients attended Sheffield Children's Hospital with PIMS-TS, 70% male. Mean age was 7.4 ± 3.7 years and mean LOS 8.7 ± 4.5 days with 50% requiring intensive care and 20% requiring inotropes. Older males had shorter LOS than younger males ( = 0.04), not seen in females. Treatment included intravenous glucocorticoids in 93%, intravenous immunoglobulins (IVIG) in 77%, Anakinra in 11%, and infliximab in 1.8%. Biomarkers correlated poorly with trajectories that peaked at different times. C-reactive protein peaked first after median 1.3 days postadmission; while LFT's and neutrophils peaked after 3 days. Age had a large effect on some biomarkers, with older children having larger troponin and ferritin, and lower lymphocytes and platelets. Cumulative dose of glucocorticoids and IVIG had a statistically significant effect on some biomarkers, but effect size was small. The heterogenous nature of PIMS-TS highlights the importance of a multidisciplinary approach. Worse inflammatory markers in older children within our cohort may be an indication of a different disease process occurring at different ages. Future work to investigate the association between age and troponin and ferritin in hyperinflammatory states is warranted.
儿科炎症性多系统综合征与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染相关（PIMS-TS）是 SARS-CoV-2 暴露后的急性并发症。PIMS-TS 中炎症标志物与抗炎药物之间的关系尚不清楚。我们回顾了英国一家大型三级中心符合皇家儿科学会和儿童健康诊断标准的所有 PIMS-TS 患者的病历和血液检查。使用对数线性混合效应模型对生物标志物轨迹进行建模，并使用多元回归评估影响住院时间（LOS）的因素。
在 2020 年 3 月至 2022 年 5 月期间，共有 56 名患者因 PIMS-TS 入住谢菲尔德儿童医院，其中 70%为男性。平均年龄为 7.4±3.7 岁，平均 LOS 为 8.7±4.5 天，50%需要重症监护，20%需要正性肌力药。与年轻男性相比，年长男性的 LOS 更短（ = 0.04），但在女性中未见这种情况。治疗包括 93%的静脉内糖皮质激素、77%的静脉内免疫球蛋白（IVIG）、11%的 Anakinra 和 1.8%的 infliximab。生物标志物与在不同时间达到峰值的轨迹相关性差。C 反应蛋白在入院后中位数 1.3 天后首次达到峰值；而 LFT 和中性粒细胞在 3 天后达到峰值。年龄对一些生物标志物有很大的影响，年龄较大的儿童肌钙蛋白和铁蛋白较高，淋巴细胞和血小板较低。糖皮质激素和 IVIG 的累积剂量对一些生物标志物有统计学显著影响，但效应大小较小。PIMS-TS 的异质性突出了多学科方法的重要性。我们队列中年龄较大的儿童炎症标志物更差可能表明在不同年龄发生不同的疾病过程。未来有必要研究年龄与肌钙蛋白和铁蛋白在高炎症状态之间的关联。
