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Wurm J, Uka A, Buettcher M, Kottanattu L, Schöbi N, Trück J, Villiger R, Ritz N, Zimmermann P. Clinical and Laboratory Biomarkers as Predictors of Severity in Pediatric Inflammatory Multisystem Syndrome-temporally Associated With SARS-CoV-2: Data From a Prospective Nationwide Surveillance Study in Switzerland. Pediatr Infect Dis J 2024; 43:675-681. [PMID: 38506504 DOI: 10.1097/inf.0000000000004332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND PIMS-TS (pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2) is a rare but serious condition in children following SARS-CoV-2 infection, characterized by a range of clinical symptoms with varying severity. Understanding risk factors for severe PIMS-TS is crucial for appropriate and timely intervention. OBJECTIVE To identify factors associated with increased PIMS-TS severity in children. METHODS In this nationwide prospective observational study, epidemiological and clinical data was collected from children <18 years of age with suspected or confirmed PIMS-TS from all 29 pediatric hospitals in Switzerland. Children were categorized into 3 groups according to admission to intensive care unit (ICU): non-ICU, ICU-moderate and ICU-severe, defined as requirement of invasive ventilation and/or inotropic support. RESULTS A total of 204 children were included; 99 (49%) were categorized as non-ICU, 50 (25%) as ICU-moderate and 55 (27%) as ICU-severe. In ICU-severe cases, respiratory and neurological symptoms were more frequent compared with non-ICU cases: 72% versus 47%, P < 0.001 and 66% versus 41%, P = 0.001, respectively. Compared with the non-ICU group, children in the ICU-severe group had lower lymphocyte counts, higher neutrophil-lymphocyte ratios, lower platelet counts, as well as higher C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin T and creatinine levels at admission. Lymphopenia and elevated troponin T levels at admission were associated with an increased risk of being in the ICU-severe group. CONCLUSION The severity of PIMS-TS may be predicted using clinical symptoms and laboratory biomarkers, which help clinicians in decision-making and management of patients.
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Affiliation(s)
- Juliane Wurm
- From the Department of Paediatrics, Fribourg Hospital, Fribourg
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
| | - Anita Uka
- Department Women-Mother-Child, Lausanne University Hospital, Lausanne
| | - Michael Buettcher
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Lucerne
- Department of Paediatrics, Paediatric Pharmacology and Pharmacometrics Research Unit at University Children's Hospital Basel, Basel
| | - Lisa Kottanattu
- Department of Paediatrics, Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona
| | - Nina Schöbi
- Division of Pediatric Infectious Diseases, Inselspital, Department of Pediatrics, Bern University Hospital, University of Bern, Bern
| | - Johannes Trück
- Division of Allergy and Immunology, University Children's Hospital Zurich and Children's Research Center, University of Zurich (UZH), Zurich
| | | | - Nicole Ritz
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Lucerne
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
| | - Petra Zimmermann
- From the Department of Paediatrics, Fribourg Hospital, Fribourg
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Guner Ozenen G, Akaslan Kara A, Kiymet E, Boncuoglu E, Sahinkaya S, Cem E, Yilmaz Celebi M, Kacar P, Gulderen M, Uras M, Yılmazer MM, Murat M, Mese T, Agin H, Bayram N, Devrim İ. The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience. Pediatr Cardiol 2022; 44:873-881. [PMID: 36210385 PMCID: PMC9548337 DOI: 10.1007/s00246-022-03017-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 09/25/2022] [Indexed: 11/30/2022]
Abstract
Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2-max. 144) months, which was statistically lower than the age of patients with normal troponin levels (P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay (P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels (P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.
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Affiliation(s)
- Gizem Guner Ozenen
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, 35210, İzmir, Turkey.
| | - Aybuke Akaslan Kara
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Elif Kiymet
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Elif Boncuoglu
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Sahika Sahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Miray Yilmaz Celebi
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Pelin Kacar
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Mustafa Gulderen
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - Meltem Uras
- Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Murat Muhtar Yılmazer
- Department of Pediatric Cardiology, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Mehmet Murat
- Department of Pediatric Cardiology, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Timur Mese
- Department of Pediatric Cardiology, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Hasan Agin
- Department of Pediatric Intensive Care Unit, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, Konak, 35210 İzmir, Turkey
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Ramoğlu MG, Karagözlü S, Bayram Ö, Bakhtiyarzada J, Aydın A, Vatansever G, Özdemir H, Tekin D, Uçar T, Çiftçi E, Tutar E. The role and efficacy of routine high-sensitivity troponin T screening in paediatric COVID-19 - ERRATUM. Cardiol Young 2022; 32:1. [PMID: 35361293 DOI: 10.1017/s1047951122001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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