Dourdouna Maria-Myrto, Mpourazani Evdoxia, Tatsi Elizabeth-Barbara, Tsirogianni Chrysanthi, Barbaressou Charikleia, Dessypris Nick, Michos Athanasios
First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece.
Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece.
J Pers Med. 2024 Sep 23;14(9):1011. doi: 10.3390/jpm14091011.
Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19 that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical, and laboratory characteristics of children diagnosed with MIS-C who were admitted to the PICU and those who did not require PICU admission. Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Demographic, clinical, and laboratory data were collected from medical records. Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR: 12.89, 95%CI: 1.35-123.41, -value = 0.03) and cardiological involvement (OR: 34.55, 95%CI: 2.2-541.91, -value = 0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 h from admission, D-dimer levels higher than 4 μg/mL and decreased Left Ventricular Ejection Fraction (LVEF) were associated with an increased risk of PICU admission (OR: 7.95, 95%CI: 1.48-42.78, -value = 0.02 and OR = 1.28, 95%CI: 1.07-1.53, -value = 0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, -value = 0.005) and were hospitalized for more days than children in the pediatric ward (median length of stay (IQR): 20 (15, 28) days vs. 8.5 (6, 14) days, -value < 0.001). The findings of this study indicate that cardiovascular and hepatic involvement and increased D-dimer levels in children with MIS-C might be associated with admission to the PICU.
儿童多系统炎症综合征（MIS-C）是新型冠状病毒肺炎（COVID-19）一种罕见但严重的感染后并发症，常需入住儿科重症监护病房（PICU）。本研究旨在比较入住PICU的MIS-C确诊儿童与无需入住PICU的儿童的人口统计学、临床和实验室特征。本病例对照研究纳入了2020年9月至2023年4月确诊为MIS-C的儿童。从病历中收集人口统计学、临床和实验室数据。50例MIS-C儿童纳入研究[年龄中位数（四分位间距）：7.5（4.3，11.4）岁，28/50（56%）为男性]。22例（22/50，44%）儿童需要入住PICU。在多因素回归分析中，肝脏受累（比值比：12.89，95%置信区间：1.35 - 123.41，P值 = 0.03）和心脏受累（比值比：34.55，95%置信区间：2.2 - 541.91，P值 = 0.01）与入住PICU显著相关。关于入院后最初48小时内的实验室和影像学参数，D - 二聚体水平高于4μg/mL和左心室射血分数（LVEF）降低与入住PICU的风险增加相关（比值比：7.95，95%置信区间：1.48 - 42.78，P值 = 0.02；比值比 = 1.28，95%置信区间：1.07 - 1.53，P值 = 0.01）。入住PICU的儿童在住院期间更易发生并发症（10/22，45.5% vs. 3/28，10.7%，P值 = 0.005），且住院天数比儿科病房的儿童更多（住院时间中位数（四分位间距）：20（15，28）天 vs. 8.5（6，14）天，P值 < 0.001）。本研究结果表明，MIS-C儿童的心血管和肝脏受累以及D - 二聚体水平升高可能与入住PICU有关。
