Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dadun.unav.edu:10171/67890 |
| Acceso en línea: | https://hdl.handle.net/10171/67890 |
| Access Level: | acceso abierto |
| Palabra clave: | SARS-CoV-2 Pediatric multisystem infammatory syndrome temporally associated with COVID-19 Kawasaki disease Toxic shock syndrome Children Critical care Shock |
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Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| title |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| spellingShingle |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain García‑Salido, A. (Alberto)|||/items/95da1e22-cb27-4dfe-a060-82d7f2019da3 SARS-CoV-2 Pediatric multisystem infammatory syndrome temporally associated with COVID-19 Kawasaki disease Toxic shock syndrome Children Critical care Shock |
| title_short |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| title_full |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| title_fullStr |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| title_full_unstemmed |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| title_sort |
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain |
| dc.creator.none.fl_str_mv |
García‑Salido, A. (Alberto)|||/items/95da1e22-cb27-4dfe-a060-82d7f2019da3 Carlos-Vicente, J.C. (Juan Carlos) de|||/items/4eec135d-58c4-451c-bcee-5051396cfbf7 Belda-Hofheinz, S. (Sylvia)|||/items/5319404b-588c-423d-827d-6d63ec7b8602 Balcells-Ramírez, J. (Joan)|||/items/f34f2c37-355c-44d3-8073-08f8692e08d0 Slöcker-Barrio, M. (Maria)|||/items/41368a12-dab7-497b-b070-4b47f216ae05 Leóz-Gordillo, I. (Inés)|||/items/9b96c950-5d9c-4023-8187-1a3e724c6666 Hernández-Yuste, A. (Alexandra)|||/items/a53a0b7f-e115-4682-b0ed-a07b8734d385 Guitart-Pardellans, C. (Carmina)|||/items/d08d9717-2f95-4eef-81da-7169ba344f72 Cuervas‑Mons-Tejedor, M. (Maite)|||/items/9265684f-3a3c-48a7-b36c-d2b6799f2f72 Huidobro-Labarga, B. (Beatriz)|||/items/93e498f0-2dc2-4347-8db7-4ffa5e4e0a0d Vázquez-Martínez, J.L. (José Luís)|||/items/29520505-9f60-471b-a5f4-89fe407b8fc5 Gutierrez-Jimeno, M. (Miriam)|||/items/7ee986c1-a635-4e4b-8a50-ce15db814c09 Oulego-Erróz, I. (Ignacio)|||/items/262c722c-9ce7-4fa2-9e6c-86cb80c78e90 Trastoy-Quintela, J. (Javier)|||/items/32b2185b-d686-49b2-86c8-dab344bec703 Medina-Monzón, C. (Carmen)|||/items/23375c49-f76c-4d31-a0d4-d7ab778017e5 Medina-Ramos, L. (Laura)|||/items/afdd1e44-27ff-464a-885f-336c5f8a48a2 Holanda-Peña, M.S. (María Soledad)|||/items/f5f41d65-7bca-4a65-82f5-78e32079815f Sorribes-Ortí, C. (Clara)|||/items/cadaf148-4e1b-4053-8229-d8d8f14d2c90 Flores-González, J.C. (José Carlos)|||/items/963ee262-2906-4486-a454-9b61ae3bb833 Hernández-Palomo, R.M. (Rosa María)|||/items/0cd5862f-8f21-46d1-aae1-6df3b5c6f4f9 Sánchez-Ganfornina, I. (Inma)|||/items/047a2e0d-b554-4141-a90f-36740a76a45b Fernández-Romero, E. (Emilia)|||/items/b8b7febb-39b9-470b-9e9e-9d8482dfb813 García‑Besteiro, M. (María)|||/items/a1636552-3fc8-46ca-b037-7cea49acd2f9 López‑Herce-Cid, J. (Jesús)|||/items/5e8d3e72-6322-4c6d-9935-d6187a49652c González-Cortés, R. (Rafael)|||/items/0cfa43aa-b06a-4b89-9b01-06116e82f84a Gil-Antón, J. (Javier)|||/items/345a8929-ee35-45f0-8fcb-55daa652b8e8 |
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García‑Salido, A. (Alberto)|||/items/95da1e22-cb27-4dfe-a060-82d7f2019da3 |
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García‑Salido, A. (Alberto)|||/items/95da1e22-cb27-4dfe-a060-82d7f2019da3 Carlos-Vicente, J.C. (Juan Carlos) de|||/items/4eec135d-58c4-451c-bcee-5051396cfbf7 Belda-Hofheinz, S. (Sylvia)|||/items/5319404b-588c-423d-827d-6d63ec7b8602 Balcells-Ramírez, J. (Joan)|||/items/f34f2c37-355c-44d3-8073-08f8692e08d0 Slöcker-Barrio, M. (Maria)|||/items/41368a12-dab7-497b-b070-4b47f216ae05 Leóz-Gordillo, I. (Inés)|||/items/9b96c950-5d9c-4023-8187-1a3e724c6666 Hernández-Yuste, A. (Alexandra)|||/items/a53a0b7f-e115-4682-b0ed-a07b8734d385 Guitart-Pardellans, C. (Carmina)|||/items/d08d9717-2f95-4eef-81da-7169ba344f72 Cuervas‑Mons-Tejedor, M. (Maite)|||/items/9265684f-3a3c-48a7-b36c-d2b6799f2f72 Huidobro-Labarga, B. (Beatriz)|||/items/93e498f0-2dc2-4347-8db7-4ffa5e4e0a0d Vázquez-Martínez, J.L. (José Luís)|||/items/29520505-9f60-471b-a5f4-89fe407b8fc5 Gutierrez-Jimeno, M. (Miriam)|||/items/7ee986c1-a635-4e4b-8a50-ce15db814c09 Oulego-Erróz, I. (Ignacio)|||/items/262c722c-9ce7-4fa2-9e6c-86cb80c78e90 Trastoy-Quintela, J. (Javier)|||/items/32b2185b-d686-49b2-86c8-dab344bec703 Medina-Monzón, C. (Carmen)|||/items/23375c49-f76c-4d31-a0d4-d7ab778017e5 Medina-Ramos, L. (Laura)|||/items/afdd1e44-27ff-464a-885f-336c5f8a48a2 Holanda-Peña, M.S. (María Soledad)|||/items/f5f41d65-7bca-4a65-82f5-78e32079815f Sorribes-Ortí, C. (Clara)|||/items/cadaf148-4e1b-4053-8229-d8d8f14d2c90 Flores-González, J.C. (José Carlos)|||/items/963ee262-2906-4486-a454-9b61ae3bb833 Hernández-Palomo, R.M. (Rosa María)|||/items/0cd5862f-8f21-46d1-aae1-6df3b5c6f4f9 Sánchez-Ganfornina, I. (Inma)|||/items/047a2e0d-b554-4141-a90f-36740a76a45b Fernández-Romero, E. (Emilia)|||/items/b8b7febb-39b9-470b-9e9e-9d8482dfb813 García‑Besteiro, M. (María)|||/items/a1636552-3fc8-46ca-b037-7cea49acd2f9 López‑Herce-Cid, J. (Jesús)|||/items/5e8d3e72-6322-4c6d-9935-d6187a49652c González-Cortés, R. (Rafael)|||/items/0cfa43aa-b06a-4b89-9b01-06116e82f84a Gil-Antón, J. (Javier)|||/items/345a8929-ee35-45f0-8fcb-55daa652b8e8 |
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Carlos-Vicente, J.C. (Juan Carlos) de|||/items/4eec135d-58c4-451c-bcee-5051396cfbf7 Belda-Hofheinz, S. (Sylvia)|||/items/5319404b-588c-423d-827d-6d63ec7b8602 Balcells-Ramírez, J. (Joan)|||/items/f34f2c37-355c-44d3-8073-08f8692e08d0 Slöcker-Barrio, M. (Maria)|||/items/41368a12-dab7-497b-b070-4b47f216ae05 Leóz-Gordillo, I. (Inés)|||/items/9b96c950-5d9c-4023-8187-1a3e724c6666 Hernández-Yuste, A. (Alexandra)|||/items/a53a0b7f-e115-4682-b0ed-a07b8734d385 Guitart-Pardellans, C. (Carmina)|||/items/d08d9717-2f95-4eef-81da-7169ba344f72 Cuervas‑Mons-Tejedor, M. (Maite)|||/items/9265684f-3a3c-48a7-b36c-d2b6799f2f72 Huidobro-Labarga, B. (Beatriz)|||/items/93e498f0-2dc2-4347-8db7-4ffa5e4e0a0d Vázquez-Martínez, J.L. (José Luís)|||/items/29520505-9f60-471b-a5f4-89fe407b8fc5 Gutierrez-Jimeno, M. (Miriam)|||/items/7ee986c1-a635-4e4b-8a50-ce15db814c09 Oulego-Erróz, I. (Ignacio)|||/items/262c722c-9ce7-4fa2-9e6c-86cb80c78e90 Trastoy-Quintela, J. (Javier)|||/items/32b2185b-d686-49b2-86c8-dab344bec703 Medina-Monzón, C. (Carmen)|||/items/23375c49-f76c-4d31-a0d4-d7ab778017e5 Medina-Ramos, L. (Laura)|||/items/afdd1e44-27ff-464a-885f-336c5f8a48a2 Holanda-Peña, M.S. (María Soledad)|||/items/f5f41d65-7bca-4a65-82f5-78e32079815f Sorribes-Ortí, C. (Clara)|||/items/cadaf148-4e1b-4053-8229-d8d8f14d2c90 Flores-González, J.C. (José Carlos)|||/items/963ee262-2906-4486-a454-9b61ae3bb833 Hernández-Palomo, R.M. (Rosa María)|||/items/0cd5862f-8f21-46d1-aae1-6df3b5c6f4f9 Sánchez-Ganfornina, I. (Inma)|||/items/047a2e0d-b554-4141-a90f-36740a76a45b Fernández-Romero, E. (Emilia)|||/items/b8b7febb-39b9-470b-9e9e-9d8482dfb813 García‑Besteiro, M. (María)|||/items/a1636552-3fc8-46ca-b037-7cea49acd2f9 López‑Herce-Cid, J. (Jesús)|||/items/5e8d3e72-6322-4c6d-9935-d6187a49652c González-Cortés, R. (Rafael)|||/items/0cfa43aa-b06a-4b89-9b01-06116e82f84a Gil-Antón, J. (Javier)|||/items/345a8929-ee35-45f0-8fcb-55daa652b8e8 |
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author author author author author author author author author author author author author author author author author author author author author author author author author |
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Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
SARS-CoV-2 Pediatric multisystem infammatory syndrome temporally associated with COVID-19 Kawasaki disease Toxic shock syndrome Children Critical care Shock |
| topic |
SARS-CoV-2 Pediatric multisystem infammatory syndrome temporally associated with COVID-19 Kawasaki disease Toxic shock syndrome Children Critical care Shock |
| description |
Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients. |
| publishDate |
2020 |
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2020 2020-01-01 2020 2020-01-01 2023 2023-11-21 |
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journal article http://purl.org/coar/resource_type/c_6501 |
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info:eu-repo/semantics/article |
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article |
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https://hdl.handle.net/10171/67890 |
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https://hdl.handle.net/10171/67890 |
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Inglés eng |
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Inglés |
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eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
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Springer Nature |
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Springer Nature |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in SpainGarcía‑Salido, A. (Alberto)|||/items/95da1e22-cb27-4dfe-a060-82d7f2019da3Carlos-Vicente, J.C. (Juan Carlos) de|||/items/4eec135d-58c4-451c-bcee-5051396cfbf7Belda-Hofheinz, S. (Sylvia)|||/items/5319404b-588c-423d-827d-6d63ec7b8602Balcells-Ramírez, J. (Joan)|||/items/f34f2c37-355c-44d3-8073-08f8692e08d0Slöcker-Barrio, M. (Maria)|||/items/41368a12-dab7-497b-b070-4b47f216ae05Leóz-Gordillo, I. (Inés)|||/items/9b96c950-5d9c-4023-8187-1a3e724c6666Hernández-Yuste, A. (Alexandra)|||/items/a53a0b7f-e115-4682-b0ed-a07b8734d385Guitart-Pardellans, C. (Carmina)|||/items/d08d9717-2f95-4eef-81da-7169ba344f72Cuervas‑Mons-Tejedor, M. (Maite)|||/items/9265684f-3a3c-48a7-b36c-d2b6799f2f72Huidobro-Labarga, B. (Beatriz)|||/items/93e498f0-2dc2-4347-8db7-4ffa5e4e0a0dVázquez-Martínez, J.L. (José Luís)|||/items/29520505-9f60-471b-a5f4-89fe407b8fc5Gutierrez-Jimeno, M. (Miriam)|||/items/7ee986c1-a635-4e4b-8a50-ce15db814c09Oulego-Erróz, I. (Ignacio)|||/items/262c722c-9ce7-4fa2-9e6c-86cb80c78e90Trastoy-Quintela, J. (Javier)|||/items/32b2185b-d686-49b2-86c8-dab344bec703Medina-Monzón, C. (Carmen)|||/items/23375c49-f76c-4d31-a0d4-d7ab778017e5Medina-Ramos, L. (Laura)|||/items/afdd1e44-27ff-464a-885f-336c5f8a48a2Holanda-Peña, M.S. (María Soledad)|||/items/f5f41d65-7bca-4a65-82f5-78e32079815fSorribes-Ortí, C. (Clara)|||/items/cadaf148-4e1b-4053-8229-d8d8f14d2c90Flores-González, J.C. (José Carlos)|||/items/963ee262-2906-4486-a454-9b61ae3bb833Hernández-Palomo, R.M. (Rosa María)|||/items/0cd5862f-8f21-46d1-aae1-6df3b5c6f4f9Sánchez-Ganfornina, I. (Inma)|||/items/047a2e0d-b554-4141-a90f-36740a76a45bFernández-Romero, E. (Emilia)|||/items/b8b7febb-39b9-470b-9e9e-9d8482dfb813García‑Besteiro, M. (María)|||/items/a1636552-3fc8-46ca-b037-7cea49acd2f9López‑Herce-Cid, J. (Jesús)|||/items/5e8d3e72-6322-4c6d-9935-d6187a49652cGonzález-Cortés, R. (Rafael)|||/items/0cfa43aa-b06a-4b89-9b01-06116e82f84aGil-Antón, J. (Javier)|||/items/345a8929-ee35-45f0-8fcb-55daa652b8e8SARS-CoV-2Pediatric multisystem infammatory syndrome temporally associated with COVID-19Kawasaki diseaseToxic shock syndromeChildrenCritical careShockBackground Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.Springer NatureDadun. Depósito Académico Digital Universidad de Navarra20232023-11-2120202020-01-0120202020-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/67890reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/678902026-06-21T12:47:57Z |
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15.300719 |