Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia.
J Intensive Care Med. 2024 Aug;39(8):785-793. doi: 10.1177/08850666241233189. Epub 2024 Feb 28.
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; < 0.01) with no difference in the frequency of coronary abnormalities ( = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
儿童多系统炎症综合征（MIS-C）与 2019 年冠状病毒病相关，其表现和严重程度差异很大，在高收入国家的死亡率较低。在这项对 16 个拉丁美洲国家的研究中，我们试图比较儿科重症监护病房（PICU）和普通病房住院患儿的 MIS-C 患者特征，并分析与严重程度、结局和治疗相关的因素。
这是一项观察性前瞻性队列研究，纳入了 2020 年 1 月至 2022 年 6 月来自拉丁美洲 REKAMLATINA 网络的 84 家医院的 1 个月至 18 岁的儿童。共纳入 1239 例 MIS-C 患儿。中位年龄为 6.5 岁（IQR 2.5-10.1）。84%（1043/1239）患儿既往健康。48%（590/1239）患儿收治于 PICU。与普通病房患儿相比，这些患儿心肌功能障碍更常见（20% vs 4%；<0.01），但冠状动脉异常的发生率无差异（=0.77）。在 PICU 患儿中，83.4%（494/589）需要血管活性药物，43.4%（256/589）因呼吸衰竭和肺炎需要有创机械通气（57% vs 32%；=0.01）。多因素分析显示，需要转入 PICU 的因素包括年龄大于 6 岁（aOR 1.76，95%CI 1.25-2.49）、休克（aOR 7.06，95%CI 5.14-9.80）、惊厥（aOR 2.44，95%CI 1.14-5.36）、血小板减少症（aOR 2.43，95%CI 1.77-3.34）、C 反应蛋白升高（aOR 1.89，95%CI 1.29-2.79）和胸片异常（aOR 2.29，95%CI 1.67-3.13）。总体死亡率为 4.8%。在拉丁美洲国家，最有可能转入 PICU 的 MIS-C 患儿是年龄大于 6 岁、伴有休克、惊厥、更严重炎症反应和胸片异常的患儿。尽管有相当比例的患者接受了充分的治疗，但与高收入国家相比，死亡率高 5 倍。
