Alvarado-Gamarra Giancarlo, Del Aguila Olguita, Dominguez-Rojas Jesús, Chonlon-Murillo Kenny, Atamari-Anahui Noé, Borcic Aida, Sánchez Sandra, Huamani-Echaccaya Pablo, Garcés-Ghilardi Raquel, Estupiftan-Vigil Matilde
Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.
Universidad San Ignacio de Loyola, Lima, Peru.
Andes Pediatr. 2022 Dec;93(6):841-850. doi: 10.32641/andespediatr.v93i6.4084.
The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America.
To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru.
A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Perú), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes.
58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 ± 3.5 years and 67.2% were males. Gastrointes tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation.
In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients.
与新型冠状病毒肺炎（COVID-19）相关的儿童多系统炎症综合征（MIS-C）虽不常见但可能致命。关于该疾病及其表型在拉丁美洲的报道较少。
描述秘鲁利马住院的MIS-C患者临床表型的特征。
对2020年4月至2021年8月在秘鲁利马国家埃加尔多·雷瓦利亚蒂·马丁斯医院诊断为MIS-C的14岁以下患者进行描述性回顾性研究。记录临床人口统计学和微生物学变量。据此，将MIS-C患者分为休克表型、无休克的川崎病（KD）表型以及发热和炎症表型，并分析其临床结局。
共分析58例患者。32例（55.2%）表现为休克表型，15例（25.8%）为无休克的川崎病（KD）表型，11例（19%）为发热和炎症表型。在休克表型中，17例有KD。平均年龄为7±3.5岁，67.2%为男性。所有表型中胃肠道和皮肤黏膜表现为主。死亡率为3.5%。冠状动脉瘤的发生率为10.2%。大多数患者接受了免疫调节和抗血小板治疗。休克表型患者在炎症标志物、血液学功能障碍和心肌损伤方面受累更严重，呼吸衰竭和有创机械通气的发生率更高。
在我们的病例系列中，休克表型患者最为常见且临床结局较差。需要对临床表型进行积极监测以便早期诊断和管理，从而改善这些患者的预后。
