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Can we predict risk for cardiac involvement in paediatric inflammatory multi-system syndrome?
Published online by Cambridge University Press: 24 January 2022
Abstract
Introduction:
Increasing recognition of paediatric inflammatory multi-system syndrome is a cause of concern. This study aimed to evaluate children with paediatric inflammatory multi-system syndrome and compare the clinical and laboratory features of children with and without cardiac involvement.
Material and methods:
We conducted a prospective single-centre study including 57 (male 37, 65%) patients with paediatric inflammatory multi-system syndrome at a tertiary care hospital between November, 2020 and March, 2021. The mean age was 8.8 ± 4.5 years (range, 10 months–16.7 years).
Results:
The most frequent symptoms were fever (100%), abdominal pain (65%) and diarrhoea (42%). SARS-CoV-2 PCR and serology tests were positive in 3 (5%) and 52 (91%) patients, respectively. Eight patients required intensive care support. Nineteen patients (33%) had cardiac involvement (valvular regurgitation in 15, left ventricular systolic dysfunction in 11 and coronary artery dilation in 1). The presence and duration of cough and intensive care admissions were significantly higher in children with cardiac involvement than those without it. The cut-off values of troponin T, pro-brain natriuretic peptide and interleukin 6 for predicting cardiac involvement were 11.65 ng/L (95% confidence interval, 0.63–0.90; sensitivity, 0.63; specificity, 0.84; area under the curve: 0.775, p = 0.009), 849.5 pg/mL (95% CI, 0.54–0.86; sensitivity, 0.63; specificity, 0.63; area under the curve: 0.706, p = 0.009) and 39.8 pg/mL (95% CI, 0.54–0.85; sensitivity, 0.63; specificity, 0.60; area under the curve: 0.698, p = 0.023), respectively.
Conclusions:
Cardiac involvement in children with paediatric inflammatory multi-system syndrome is common. The risk of cardiac involvement can be predicted by troponin T, pro-brain natriuretic peptide and interleukin 6 levels.
Keywords
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- Copyright
- © The Author(s), 2022. Published by Cambridge University Press
References
World Health Organization. Coronavirus disease (COVID-19) situation reports [Internet]. Retrieved January 10, 2021, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Google Scholar
Toubiana, J, Poirault, C, Corsia, A, et al. Kawasaki like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094.CrossRefGoogle ScholarPubMed
Dong, Y, Mo, X, Hu, Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145: e20200702.CrossRefGoogle ScholarPubMed
Riphagen, S, Gomez, X, Gonzalez-Martinez, C, Wilkinson, N, Theocharis, P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607–1608.CrossRefGoogle ScholarPubMed
Verdoni, L, Mazza, A, Gervasoni, A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–1778.CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated With SARS-CoV-2. JAMA 2020, 324:259–269.CrossRefGoogle Scholar
World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 [Internet]. Retrieved January 11, 2021, from https://www.who.int/news-room/commentaries/detail/multisystem-inflammatorysyndrome-in-children-and-adolescents-with-covid-19
Google Scholar
Centers for Disease Control and Prevention.Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) [Internet]. Retrieved January 11, 2021, from https://emergency.cdc.gov/han/2020/han00432.asp
Google Scholar
RCPCH.Royal College of Paediatrics and Child Health Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 [Internet]. Retrieved January 11, 2021, from https://www.rcpch.ac.uk/resources/guidance-paediatric-multisysteminflammatory-syndrome-temporally-associated-covid-19-pims, Accessed 11 January 2021.Google Scholar
RCPCH. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Retrieved from https://www.rcpch.ac.uk/resources/guidancepaediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19
Google Scholar
Bertoncelli, D, Guidarini, M, Della Greca, A, et al. COVID19: potential cardiovascular issues in pediatric patients. Acta Biomed 2020; 91: 177–183.Google ScholarPubMed
Kaushik, A, Gupta, S, Sood, M, Sharma, S, Verma, S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J 2020; 39: e340–e346.CrossRefGoogle ScholarPubMed
Ayres, NA, Miller-Hance, W, Fyfe, DA, et al. Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: report from the task force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2005; 18: 91–98.CrossRefGoogle ScholarPubMed
Shen, KL, Yang, YH, Jiang, RM, et al. Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition). World J Pediatr 2020; 16: 232–239.CrossRefGoogle ScholarPubMed
Wu, Z, McGoogan, JM. Characteristics of and important lessons from the coronavirus disease 2019 (covid-19) outbreak in china. Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239–1242.CrossRefGoogle Scholar
Dhochak, N, Singhal, T, Kabra, SK, Lodha, R. Pathophysiology of COVID-19: Why children fare better than adults? Indian J Pediatr 2020; 87: 537–546.CrossRefGoogle ScholarPubMed
Walker, DM, Tolentino, VR. COVID-19: the impact on pediatric emergency care. Pediatr Emerg Med Pract 2020; 17: 1–27.Google ScholarPubMed
Kaushik, S, Aydin, SI, Derespina, KR, et al. Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection: a multi-institutional study from New York City. J Pediatr 2020; 224: 24–29.CrossRefGoogle ScholarPubMed
Belot, A, Antona, D, Renolleau, S, et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May2020. Euro Surveill 2020; 25: 2001010.CrossRefGoogle Scholar
Cheung, EW, Zachariah, P, Gorelik, M, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA 2020; 324: 294–296.CrossRefGoogle ScholarPubMed
Dufort, EM, Koumans, EH, Chow, EJ, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020; 383: 347–358.CrossRefGoogle ScholarPubMed
Feldstein, LR, Rose, EB, Horwitz, SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383: 334–346.CrossRefGoogle ScholarPubMed
Mamishi, S, Movahedi, Z, Mohammadi, M, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infect 2020; 148: e196.CrossRefGoogle ScholarPubMed
Davies, P, Evans, C, Kanthimathinathan, HK, et al. Intensive care admissions of children with paediatric inflammatorymultisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4: 669–677.CrossRefGoogle Scholar
Moraleda, C, Serna-Pascual, M, Soriano-Arandes, A, et al. Multi-inflammatory syndrome in children related to SARS-CoV-2 in Spain. Clin Infect Dis 2021; 72: e397–e401.CrossRefGoogle ScholarPubMed
Chiotos, K, Bassiri, H, Behrens, EM, et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc 2020; 9: 393–398.CrossRefGoogle ScholarPubMed
Lee, PY, Day-Lewis, M, Henderson, LA, et al. Distinct clinical and immunological features of SARS-COV-2-induced multisystem inflammatory syndrome in children. J Clin Invest 2020; 130: 5942–5950.CrossRefGoogle ScholarPubMed
Balasubramanian, S, Nagendran, TM, Ramachandran, B, Ramanan, AV. Hyperinflammatory syndrome in a child with COVID-19 treated successfully with intravenous immunoglobulin and tocilizumab. Indian Pediatr 2020; 57: 681–683.CrossRefGoogle Scholar
White, M, Tiesman, B, Handforth, J, Kenny, J. Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): the Evelina Experience. Arch Dis Child 2020; 105: 1025–1027.CrossRefGoogle ScholarPubMed
Ocal Demir, S, Tosun, O, Ozturk, K, et al. SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C). A single center’s experience. Minerva Pediatr (Torino) 2021, 10.23736/S2724-5276.21.06327-8.Google ScholarPubMed
Miller, J, Cantor, A, Zachariah, P, Ahn, D, Martinez, M, Margolis, KG. Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: a single center experience of 44 cases. Gastroenterology 2020; 159: 1571–1574.CrossRefGoogle Scholar
Pouletty, M, Borocco, C, Ouldali, N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis 2020; 79: 999–1006.CrossRefGoogle ScholarPubMed
Matsubara, D, Kauffman, HL, Wang, Y, et al. Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol 2020; 76: 1947–1961.CrossRefGoogle ScholarPubMed
Theocharis, P, Wong, J, Pushparajah, K, et al. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22: 896–903.CrossRefGoogle Scholar
Malviya, A, Mishra, A. Childhood inflammatory syndrome: an emerging disease wit prominent cardiovascular involvement- a scoping review. SN Compr Clin Med 2021; 3: 1–12.CrossRefGoogle Scholar
Shi, S, Qin, M, Cai, Y, et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease. Eur Heart J 2020; 2019: 41 2070–2079.Google Scholar
Gao, L, Jiang, D, Wen, XS, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res 2020; 21: 83.CrossRefGoogle ScholarPubMed
Niaz, T, Hope, K, Fremed, M, et al. Role of pediatric cardiologist in the COVID-19 pandemic. Pediatr Cardiol 2021; 42: 19–35.CrossRefGoogle ScholarPubMed
Sperotto, F, Friedman, KG, Son, MBF, VanderPluym, CJ, Newburger, JW, Dionne, A. Cardiac manifestations in SARS-CoV-2 associated multisystem inflammatory syndrome in children: comprehensive review and proposed clinical approach. Eur J Pediatr 2021; 180: 307–322.CrossRefGoogle ScholarPubMed