Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill...

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Autores principales: Lorena Acevedo, Byron Enrique Piñeres-Olave, Laura Fernanda Niño-Serna, Liliana Mazzillo Vega, Ivan Jose Ardila Gomez, Shayl Chacón, Juan Camilo Jaramillo-Bustamante, Hernando Mulett-Hoyos, Otto González-Pardo, Eliana Zemanate, Ledys Izquierdo, Jaime Piracoca Mejìa, Jose Luis Junco González, Beatriz Giraldo Duran, Carolina Bonilla Gonzalez, Helen Preciado, Rafael Orozco Marun, Martha I Alvarez-Olmos, Carolina Giraldo Alzate, Jorge Rojas, Juan Carlos Salazar-Uribe, Juan-Manuel Anaya, Jaime Fernández-Sarmiento
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Publicado: BMC 2021
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spelling oai:doaj.org-article:864c1248aa4443e9bf330327a3fc03822021-11-21T12:33:28ZMortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)10.1186/s12887-021-02974-91471-2431https://doaj.org/article/864c1248aa4443e9bf330327a3fc03822021-11-01T00:00:00Zhttps://doi.org/10.1186/s12887-021-02974-9https://doaj.org/toc/1471-2431Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.Lorena AcevedoByron Enrique Piñeres-OlaveLaura Fernanda Niño-SernaLiliana Mazzillo VegaIvan Jose Ardila GomezShayl ChacónJuan Camilo Jaramillo-BustamanteHernando Mulett-HoyosOtto González-PardoEliana ZemanateLedys IzquierdoJaime Piracoca MejìaJose Luis Junco GonzálezBeatriz Giraldo DuranCarolina Bonilla GonzalezHelen PreciadoRafael Orozco MarunMartha I Alvarez-OlmosCarolina Giraldo AlzateJorge RojasJuan Carlos Salazar-UribeJuan-Manuel AnayaJaime Fernández-SarmientoBMCarticleSepsisSARS-CoV2PIMS-TSinflammatorymortalityPediatricsRJ1-570ENBMC Pediatrics, Vol 21, Iss 1, Pp 1-12 (2021)
institution DOAJ
collection DOAJ
language EN
topic Sepsis
SARS-CoV2
PIMS-TS
inflammatory
mortality
Pediatrics
RJ1-570
spellingShingle Sepsis
SARS-CoV2
PIMS-TS
inflammatory
mortality
Pediatrics
RJ1-570
Lorena Acevedo
Byron Enrique Piñeres-Olave
Laura Fernanda Niño-Serna
Liliana Mazzillo Vega
Ivan Jose Ardila Gomez
Shayl Chacón
Juan Camilo Jaramillo-Bustamante
Hernando Mulett-Hoyos
Otto González-Pardo
Eliana Zemanate
Ledys Izquierdo
Jaime Piracoca Mejìa
Jose Luis Junco González
Beatriz Giraldo Duran
Carolina Bonilla Gonzalez
Helen Preciado
Rafael Orozco Marun
Martha I Alvarez-Olmos
Carolina Giraldo Alzate
Jorge Rojas
Juan Carlos Salazar-Uribe
Juan-Manuel Anaya
Jaime Fernández-Sarmiento
Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
description Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.
format article
author Lorena Acevedo
Byron Enrique Piñeres-Olave
Laura Fernanda Niño-Serna
Liliana Mazzillo Vega
Ivan Jose Ardila Gomez
Shayl Chacón
Juan Camilo Jaramillo-Bustamante
Hernando Mulett-Hoyos
Otto González-Pardo
Eliana Zemanate
Ledys Izquierdo
Jaime Piracoca Mejìa
Jose Luis Junco González
Beatriz Giraldo Duran
Carolina Bonilla Gonzalez
Helen Preciado
Rafael Orozco Marun
Martha I Alvarez-Olmos
Carolina Giraldo Alzate
Jorge Rojas
Juan Carlos Salazar-Uribe
Juan-Manuel Anaya
Jaime Fernández-Sarmiento
author_facet Lorena Acevedo
Byron Enrique Piñeres-Olave
Laura Fernanda Niño-Serna
Liliana Mazzillo Vega
Ivan Jose Ardila Gomez
Shayl Chacón
Juan Camilo Jaramillo-Bustamante
Hernando Mulett-Hoyos
Otto González-Pardo
Eliana Zemanate
Ledys Izquierdo
Jaime Piracoca Mejìa
Jose Luis Junco González
Beatriz Giraldo Duran
Carolina Bonilla Gonzalez
Helen Preciado
Rafael Orozco Marun
Martha I Alvarez-Olmos
Carolina Giraldo Alzate
Jorge Rojas
Juan Carlos Salazar-Uribe
Juan-Manuel Anaya
Jaime Fernández-Sarmiento
author_sort Lorena Acevedo
title Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
title_short Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
title_full Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
title_fullStr Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
title_full_unstemmed Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)
title_sort mortality and clinical characteristics of multisystem inflammatory syndrome in children (mis-c) associated with covid-19 in critically ill patients: an observational multicenter study (misco study)
publisher BMC
publishDate 2021
url https://doaj.org/article/864c1248aa4443e9bf330327a3fc0382
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