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); Carlos-Vicente, J.C. (Juan Carlos) de; Belda-Hofheinz, S. (Sylvia); Balcells-Ramírez, J. (Joan); Slöcker-Barrio, M. (Maria); Leóz-Gordillo, I. (Inés); Hernández-Yuste, A. (Alexandra); Guitart-Pardellans, C. (Carmina); Cuervas‑Mons-Tejedor, M. (Maite); Huidobro-Labarga, B. (Beatriz); Vázquez-Martínez, J.L. (José Luís); Gutierrez-Jimeno, M. (Miriam); Oulego-Erróz, I. (Ignacio); Trastoy-Quintela, J. (Javier); Medina-Monzón, C. (Carmen); Medina-Ramos, L. (Laura); Holanda-Peña, M.S. (María Soledad); Antón, J. (Javier); Sorribes-Ortí, C. (Clara); Flores-González, J.C. (José Carlos); Hernández-Palomo, R.M. (Rosa María); Sánchez-Ganfornina, I. (Inma); Fernández-Romero, E. (Emilia); García‑Besteiro, M. (María); López‑Herce-Cid, J. (Jesús); González-Cortés, R. (Rafael)

Keywords:

SARS-CoV-2
Pediatric multisystem infammatory syndrome temporally associated with COVID-19
Kawasaki disease
Toxic shock syndrome
Children
Critical care
Shock

Issue Date:

2020

Publisher:

Springer Nature

ISSN:

1364-8535

Note:

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Citation:

García‑Salido, A. (Alberto); Carlos-Vicente, J.C. (Juan Carlos) de; Belda-Hofheinz, S. (Sylvia); et al. "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". Critical care. 24 (1), 2020, 666

Abstract

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.

URI:

https://hdl.handle.net/10171/67890

DOI:

10.1186/s13054-020-03332-4

Appears in Collections:

DA - CUN - Pediatría - Artículos de revista

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