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Poddar NK, Khan A, Fatima F, Saxena A, Ghaley G, Khan S. Association of mTOR Pathway and Conformational Alterations in C-Reactive Protein in Neurodegenerative Diseases and Infections. Cell Mol Neurobiol 2023; 43:3815-3832. [PMID: 37665407 DOI: 10.1007/s10571-023-01402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
Inflammatory biomarkers have been very useful in detecting and monitoring inflammatory processes along with providing helpful information to select appropriate therapeutic strategies. C-reactive protein (CRP) is a nonspecific, but quite useful medical acute inflammatory biomarker and is associated with persistent chronic inflammatory processes. Several studies suggest that different levels of CRP are correlated with neurological disorders such as Alzheimer's disease (AD). However, dynamics of CRP levels have also been observed in virus/bacterial-related infections leading to inflammatory responses and this triggers mTOR-mediated pathways for neurodegeneration diseases. The biophysical structural transition from CRP to monomeric CRP (mCRP) and the significance of the ratio of CRP levels on the onset of symptoms associated with inflammatory response have been discussed. In addition, mTOR inhibitors act as immunomodulators by downregulating the expression of viral infection and can be explored as a potential therapy for neurological diseases.
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Affiliation(s)
- Nitesh Kumar Poddar
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007.
| | - Arshma Khan
- Department of Biotechnology, Invertis University, Bareilly, Uttar Pradesh, India, 243123
| | - Falak Fatima
- Amity Institute of Biotechnology, Amity University, Uttar Pradesh, Noida, India, 201301
| | - Anshulika Saxena
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Garima Ghaley
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Shahanavaj Khan
- Department of Medical Lab Technology, Indian Institute of Health and Technology (IIHT), Deoband, Saharanpur, Uttar Pradesh, India, 247554.
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Liu JJ, Sun YM, Xu Y, Mei HW, Guo W, Li ZL. Pathophysiological consequences and treatment strategy of obstructive jaundice. World J Gastrointest Surg 2023; 15:1262-1276. [PMID: 37555128 PMCID: PMC10405123 DOI: 10.4240/wjgs.v15.i7.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/29/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.
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Affiliation(s)
- Jun-Jian Liu
- Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China
| | - Yi-Meng Sun
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Yan Xu
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Han-Wei Mei
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Wu Guo
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Zhong-Lian Li
- Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China
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Schultz CM, Burke LA, Kent DA. A Systematic Review and Meta-analysis of the Initial Literature Regarding COVID-19 Symptoms in Children in the United States. J Pediatr Health Care 2023:S0891-5245(23)00055-X. [PMID: 36948964 PMCID: PMC10020381 DOI: 10.1016/j.pedhc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION COVID-19 symptom presentation among adults is mostly understood. However, understanding COVID-19 symptom presentation in children lags. METHOD A literature search was conducted in three electronic databases. Twenty-three initial publications addressing COVID-19 symptom presentation among hospitalized children in the United States met the criteria for review and meta-analysis. RESULTS Fever, the most common symptom, was present in nearly all cases. Gastrointestinal, respiratory, oral symptoms, and rash occurred in over half of the cases. Disease severity assessment showed that comorbidities were present in one-third of patients; intensive care was needed for half of the patients, and supplemental oxygen and mechanical ventilation were needed by 13.3% and 7.1%, respectively. DISCUSSION The magnitude and significance of COVID-19 symptoms in children compared with those in adults and three common childhood viral illnesses: influenza, respiratory syncytial virus, and gastroenteritis, are discussed. Important clinical differences were found that may help clinicians distinguish COVID-19 from other illnesses.
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Abstract
INTRODUCTION Since the end of 2019, a new disease outbreak has been spreading worldwide, after starting from Wuhan, China. The viral pathogen responsible for the disease was named as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), and for the illness the acronym COVID-19 was coined (COronaVIrus Disease 2019). Viral pathogenesis, epidemiology, and clinics are still somewhat obscure, when occurring during childhood the most. The aim of this study was to evaluate the features of liver involvement and damage in course of COVID-19. EVIDENCE ACQUISITION An insight into what is known as to COVID-19 and hepatic damage in adulthood as well as pediatric age was given. All the most relevant papers up to 15/10/2020 were identified and discussed. An extensive search strategy was carried out to identify all paper published from December 1st, 2019, to September 5, 2020, combining the key words "coronavirus," "coronavirus infection," "SARS-CoV-2," "COVID-19," "liver," "liver injury," "hepatic injury," "children," "pediatric" in key electronic bibliographic databases (PubMed, Google Scholar), following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. EVIDENCE SYNTHESIS Establishing whether liver damage is due to a direct viral action or host immune system inflammatory reaction or consequence of the administered drugs or secondary to another organ failure (for example the heart) is difficult. What is sure is the fact that liver function should be checked at the time of admission to hospital and during hospitalization. CONCLUSIONS In conclusion, liver involvement during COVID-19 is likely due to a multifactorial origin. An aberrant immune system reaction to SARS-CoV-2 is probably the most important underlying trigger, though more extended studies are needed for a definitive confirmation. The markers of liver injury should be carefully in each patient admitted for COVID-19: in fact, in case of altered hepatic markers, a specific therapy to protect liver is needed.
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Affiliation(s)
- Simone Mameli
- Graduate School in Pediatrics, University of Cagliari, Cagliari, Italy
| | - Maria A Marcialis
- Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy
| | - Pier P Bassareo
- Mater Misericordiae University Hospital and Our Lady's Children's Hospital Crumlin, University College of Dublin, Dublin, Ireland -
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children generally have milder presentations, but severe disease can occur in all ages. MIS-C and persistent post-acute COVID-19 symptoms can be experienced by children with previous infection and emphasize the need for infection prevention. Optimal treatment for COVID-19 is not known, and clinical trials should include children to guide therapy. Vaccines are the best tool at preventing infection and severe outcomes of COVID-19. Children suffered disproportionately during the pandemic not only from SARS-CoV-2 infection but because of disruptions to daily life, access to primary care, and worsening income inequalities.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356423, Seattle, WA 98195, USA.
| | - Janet A Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, 4800 Sand Point Way NE - MA7.234, Seattle, WA 98105, USA
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Severe Cholestatic Hepatitis Secondary to SARS-CoV-2. ACG Case Rep J 2022; 9:e00753. [PMID: 35359752 PMCID: PMC8963841 DOI: 10.14309/crj.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Liver injury is a common manifestation of coronavirus disease 2019 (COVID-19), with most injuries manifesting as transient mild hepatocellular injury. Cholestatic injury occurs less commonly and is typically mild. Severe cholestatic injury is rare, with only 4 cases reported in the literature. We present a 70-year-old woman with no known liver disease who presented with severe COVID-19 and developed severe cholestatic hepatitis. A liver biopsy was performed demonstrating bile duct injury, uncommonly reported in patients with COVID-19. This complication needs greater awareness because it has been known to cause progressive liver disease requiring transplantation.
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Nicastro E, Ebel NH, Kehar M, Czubkowski P, Ng VL, Michaels MG, Lobritto SJ, Martinez M, Indolfi G. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper. J Pediatr Gastroenterol Nutr 2022; 74:159-170. [PMID: 34694269 PMCID: PMC8673661 DOI: 10.1097/mpg.0000000000003339] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
ABSTRACT Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, Toronto, ON, Canada
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Steven J. Lobritto
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Mercedes Martinez
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Giuseppe Indolfi
- Meyer Children's University Hospital, Department NEUROFARBA, University of Florence, Firenze, Italy
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Tamrazova OB, Stadnikova AS, Rudikova EV. Cutaneous manifestations in children with the new coronavirus infection COVID-19. RUDN JOURNAL OF MEDICINE 2021. [DOI: 10.22363/2313-0245-2021-25-1-16-24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In late 2019, a new viral infection appeared in China, which spread around the world, causing a pandemic. The causative agent of the new coronavirus infection COVID-19 is the SARS-CoV-2 coronavirus. The review presents modern data on the epidemiology, pathogenesis and course of the novel coronavirus infection COVID-19 in children. Chinese, American and European scientists have described a variety of cutaneous manifestations in children with COVID-19. The article provides a literature review of the cutaneous manifestations of COVID-19 coronavirus infection in children. During our own observation of 301 patients with coronavirus infection COVID-19 caused by SARS-CoV-2 at the Bashlyaevs Children Hospital in Moscow from May 17 to November 16, 2020, it was revealed that 39 (13 %) patients had skin manifestations. The article presents a classification of skin manifestations characteristic of COVID-19. A brief description of each group is given.
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Perez A, Cantor A, Rudolph B, Miller J, Kogan‐Liberman D, Gao Q, Da Silva B, Margolis KG, Ovchinsky N, Martinez M. Liver involvement in children with SARS-COV-2 infection: Two distinct clinical phenotypes caused by the same virus. Liver Int 2021; 41:2068-2075. [PMID: 33826804 PMCID: PMC8251417 DOI: 10.1111/liv.14887] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19). METHODS This is a retrospective study of patients ≤21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C. RESULTS E-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (P < .001), immunocompromised status (P = .04), and chronic liver disease (P = .01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, P = .01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (P = .001), Hispanic (P = .04), or Black (P < .001). In MIS-C, male gender (OR 5.3, P = .02) and Black race (OR 4.4, P = .04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality. CONCLUSION E-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.
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Affiliation(s)
- Adriana Perez
- Division of Gastroenterology, Hepatology and NutritionAlbert Einstein College of MedicineChildren's Hospital at MontefioreBronxNYUSA
| | - Amanda Cantor
- Division of Pediatric Gastroenterology, Hepatology and NutritionColumbia University Irving Medical Center Morgan Stanley Children's HospitalNew YorkNYUSA
| | - Bryan Rudolph
- Division of Gastroenterology, Hepatology and NutritionAlbert Einstein College of MedicineChildren's Hospital at MontefioreBronxNYUSA
| | - Jonathan Miller
- Division of Pediatric Gastroenterology, Hepatology and NutritionColumbia University Irving Medical Center Morgan Stanley Children's HospitalNew YorkNYUSA
| | - Debora Kogan‐Liberman
- Division of Gastroenterology, Hepatology and NutritionAlbert Einstein College of MedicineChildren's Hospital at MontefioreBronxNYUSA
| | - Qi Gao
- Department of BiostatisticsAlbert Einstein College of MedicineBronxNYUSA
| | - Bernardo Da Silva
- Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Kara G. Margolis
- Division of Pediatric Gastroenterology, Hepatology and NutritionColumbia University Irving Medical Center Morgan Stanley Children's HospitalNew YorkNYUSA
| | - Nadia Ovchinsky
- Division of Gastroenterology, Hepatology and NutritionAlbert Einstein College of MedicineChildren's Hospital at MontefioreBronxNYUSA
| | - Mercedes Martinez
- Division of Pediatric Gastroenterology, Hepatology and NutritionColumbia University Irving Medical Center Morgan Stanley Children's HospitalNew YorkNYUSA
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Abstract
Since its initial onset in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread quickly across the globe, resulting in the potentially life-threatening respiratory coronavirus disease 2019 (COVID-19). Although less commonly reported, COVID-19 has also been associated with gastrointestinal and hepatic manifestations, which may occur more frequently in children. This has also led to concern about the susceptibility of children to the SARS-CoV-2 virus who have underlying chronic digestive disease and may be treated with immune suppression. As such, recommendations and expert consensus regarding the management of chronic gastrointestinal and hepatobiliary disease have been of great interest during the pandemic and international database reporting has informed our understanding. The impact of COVID-19 on the gastrointestinal tract and its influence on the management of pediatric digestive disease is reviewed in this article. [Pediatr Ann. 2021;50(8):e315-e319.].
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Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child 2021; 106:440-448. [PMID: 33593743 PMCID: PMC8070630 DOI: 10.1136/archdischild-2020-321385] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity. DESIGN Systematic review and meta-analysis. SETTING Between 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0-19 years old) COVID-19 were considered for inclusion. MAIN OUTCOMES AND MEASURES The pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity. RESULTS 129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample. CONCLUSION Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.
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Affiliation(s)
- Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fiona Muttalib
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Global Health & Development, Aga Khan University, Karachi, Pakistan
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Fernandes DM, Oliveira CR, Guerguis S, Eisenberg R, Choi J, Kim M, Abdelhemid A, Agha R, Agarwal S, Aschner JL, Avner JR, Ballance C, Bock J, Bhavsar SM, Campbell M, Clouser KN, Gesner M, Goldman DL, Hammerschlag MR, Hymes S, Howard A, Jung HJ, Kohlhoff S, Kojaoghlanian T, Lewis R, Nachman S, Naganathan S, Paintsil E, Pall H, Sy S, Wadowski S, Zirinsky E, Cabana MD, Herold BC. Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth. J Pediatr 2021; 230:23-31.e10. [PMID: 33197493 PMCID: PMC7666535 DOI: 10.1016/j.jpeds.2020.11.016] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity. STUDY DESIGN We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut. RESULTS We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.
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Affiliation(s)
- Danielle M Fernandes
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY.
| | | | - Sandra Guerguis
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Ruth Eisenberg
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Jaeun Choi
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Mimi Kim
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Ashraf Abdelhemid
- Department of Pediatrics, Kings County Hospital Center, Brooklyn, NY
| | - Rabia Agha
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY
| | - Saranga Agarwal
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Judy L Aschner
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Jeffrey R Avner
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY
| | - Cathleen Ballance
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Joshua Bock
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Sejal M Bhavsar
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Melissa Campbell
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Katharine N Clouser
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Matthew Gesner
- Department of Pediatrics, Kings County Hospital Center, Brooklyn, NY
| | - David L Goldman
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | | | - Saul Hymes
- Department of Pediatrics, Stony Brook University Renaissance Hospital, Stony Brook, NY
| | - Ashley Howard
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Hee-Jin Jung
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Stephan Kohlhoff
- Department of Pediatrics, SUNY Downstate Medical Center University Hospital, Brooklyn, NY
| | | | - Rachel Lewis
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Sharon Nachman
- Department of Pediatrics, Stony Brook University Renaissance Hospital, Stony Brook, NY
| | - Srividya Naganathan
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Harpreet Pall
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Sharlene Sy
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Stephen Wadowski
- Department of Pediatrics, SUNY Downstate Medical Center University Hospital, Brooklyn, NY
| | - Elissa Zirinsky
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Michael D Cabana
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Betsy C Herold
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
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