1
|
Benvenuto S, Avcin T, Taddio A. Multisystem inflammatory syndrome in children: A review. Acta Paediatr 2024; 113:2011-2023. [PMID: 38714363 DOI: 10.1111/apa.17267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
AIM To comprehensively review the literature on multisystem inflammatory syndrome in children (MIS-C). METHODS Narrative review of relevant studies published between April 2020 and January 2024. RESULTS MIS-C is a SARS-CoV-2-related hyperinflammatory syndrome developing 2-6 weeks after COVID-19 in genetically susceptible individuals. Persisting fever, mucocutaneous manifestations, GI and cardiac involvement, together with lymphopenia and elevated inflammatory and cardiac markers are the main clinical features. It is believed to recognise some pathogenetic and clinical overlap with Kawasaki disease. New case definitions have been proposed after an assessment of the diagnostic performance of existing criteria; epidemiological criterion is however progressively losing its usefulness as the pandemic turns into an endemic and in the areas with the highest rates of COVID-19 vaccination. Current guidelines recommend both intravenous immunoglobulin and glucocorticoids in the first-line immunomodulatory treatment, mainly based on comparative retrospective cohorts; the actual role of biologics remains to be adequately established. Strict follow-up is mandatory, especially for those with severe cardiac involvement, as longitudinal studies evaluate the long-term evolution of cardiac damage. CONCLUSION In this paper, we review the epidemiological, pathogenetic, clinical and prognostic features of MIS-C, and outline the main questions which still remain unanswered after more than 3 years of research.
Collapse
Affiliation(s)
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrea Taddio
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
2
|
Ludwikowska KM, Tokarczyk M, Paleczny B, Tracewski P, Szenborn L, Kusa J. Clinical Significance of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide in Pediatric Patients: Insights into Their Utility in the Presence or Absence of Pre-Existing Heart Conditions. Int J Mol Sci 2024; 25:8781. [PMID: 39201467 PMCID: PMC11354905 DOI: 10.3390/ijms25168781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
The clinical significance of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in pediatric patients remains an area of evolving understanding, particularly regarding their utility in the presence or absence of pre-existing heart conditions. While clear cutoff values and established roles in heart failure are understood in adult patients, pediatric norms vary with age, complicating interpretation. Notably, the emergence of multi-system inflammatory syndrome in children (MIS-C) has highlighted the importance of these markers not only in the detection of acute heart failure but also as a marker of disease severity and even as a differential diagnosis tool. This review summarizes current knowledge on the utility of BNP and NT-proBNP in pediatric patients. Their unique physiology, including circulation and compensation mechanisms, likely influence BNP and NT-proBNP release, potentially even in non-heart failure states. Factors such as dynamic volemic changes accompanying inflammatory diseases in children may contribute. Thus, understanding the nuanced roles of BNP and NT-proBNP in pediatric populations is crucial for the accurate diagnosis, management, and differentiation of cardiac and non-cardiac conditions.
Collapse
Affiliation(s)
- Kamila Maria Ludwikowska
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Monika Tokarczyk
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Bartłomiej Paleczny
- Department of Physiology and Pathophysiology, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland;
| | - Paweł Tracewski
- Department of Pediatric Cardiology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Kamieńskiego 73a, 51-124 Wrocław, Poland; (P.T.); (J.K.)
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Jacek Kusa
- Department of Pediatric Cardiology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Kamieńskiego 73a, 51-124 Wrocław, Poland; (P.T.); (J.K.)
- Pediatric Cardiology Department, Medical University of Silesia, Medyków 16, 40-752 Katowice, Poland
| |
Collapse
|
3
|
Mahmoudi S, Pourakbari B, Jafari E, Eshaghi H, Movahedi Z, Heydari H, Mohammadian M, Rahmati MB, Tariverdi M, Shalchi Z, Navaeian A, Mamishi S. Predictive factors for COVID-19 severity and mortality in hospitalized children. BMC Infect Dis 2024; 24:757. [PMID: 39085793 PMCID: PMC11290188 DOI: 10.1186/s12879-024-09675-5] [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: 01/09/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Understanding the factors influencing disease progression and severity in pediatric COVID-19 cases is essential for effective management and intervention strategies. This study aimed to evaluate the discriminative ability of clinical and laboratory parameters to identify predictors of COVID-19 severity and mortality in hospitalized children. METHODS In this multicenter retrospective cohort study, we included 468 pediatric patients with COVID-19. We developed a predictive model using their demographic, clinical, and laboratory data. The performance of the model was assessed using various metrics including sensitivity, specificity, positive predictive value rates, and receiver operating characteristics (ROC). RESULTS Our findings demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.818 for severity and 0.873 for mortality prediction. Key risk factors for severe COVID-19 in children include low albumin levels, elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), and underlying medical conditions. Furthermore, ROC curve analysis highlights the predictive value of CRP, LDH, and albumin, with AUC values of 0.789, 0.752, and 0.758, respectively. CONCLUSION Our study indicates that laboratory values are valuable in predicting COVID-19 severity in children. Various factors, including CRP, LDH, and albumin levels, demonstrated statistically significant differences between patient groups, suggesting their potential as predictive markers for disease severity. Implementing predictive analyses based on these markers could aid clinicians in making informed decisions regarding patient management.
Collapse
Affiliation(s)
- Shima Mahmoudi
- Biotechnology Centre, Silesian University of Technology, Gliwice, 44-100, Poland
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Erfaneh Jafari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Eshaghi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Movahedi
- Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Hosein Heydari
- Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Maryam Mohammadian
- Department of Pediatric, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Bagher Rahmati
- Department of Pediatric, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Marjan Tariverdi
- Department of Pediatric, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zohreh Shalchi
- Department of Pediatric, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amene Navaeian
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
4
|
Caorsi R, Consolaro A, Speziani C, Sozeri B, Ulu K, Faugier-Fuentes E, Menchaca-Aguayo H, Ozen S, Sener S, Akhter Rahman S, Imnul Islam M, Haerynck F, Simonini G, Mastri MV, Avcin T, Sršen S, de Albuquerque Pedrosa Fernandes T, Stanevicha V, Vojinovic J, Sobh A, Fingerhutova S, Minxova L, Gagro A, Rodrigues Fonseca A, Pandya D, Varbanova B, Sánchez-Manubens J, Ganeva M, Montin D, Boyarchuk O, Minghini A, Bracaglia C, Brogan P, Candotti F, Cattalini M, Meyts I, Minoia F, Taddio A, Wouters C, De Benedetti F, Bovis F, Ravelli A, Ruperto N, Gattorno M, Bilginer Y, Laila K, Islam MM, Meertens B, Hoste L, Dehoorne J, Schelstraete P, Vandekerckhove K, Willems J, Matthijs I, Filocamo E Gisella Beatrice Beretta G, Magalhaes CS, Chubata O, Ricci F, Vukovic A, Temelkova K, Avramovic MZ, Emersic N, Bizjak M, Vesel T, Rodrigues MF, Gasparello de Almeida R, Lukjanovica K, Elnagdy MH, Soliman A, Terifajova E, Brejchova I, Magner M, Myrup C, Vougiouka O, Jelusic M, La Torre F, Rigante D, Maggio MC, Verdoni L, Rubio-Perez N, Cornejo GV, Villarreal Trevino AV, Brito I, Oliveira-Ramos F, Alexeeva E, Chasnyk V, Arkachaisri T, Boyko Y, Vyzhga Y, Samsonenko S. The HyperPed-COVID international registry: Impact of age of onset, disease presentation and geographical distribution on the final outcome of MIS-C. J Autoimmun 2024; 147:103265. [PMID: 38838452 DOI: 10.1016/j.jaut.2024.103265] [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: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The aim of the study was to establish an international multicenter registry to collect data on patients with Multisystem Inflammatory Syndrome in Children (MIS-C), in order to highlight a relationship between clinical presentation, age of onset and geographical distribution on the clinical outcome. STUDY DESIGN Multicenter retrospective study involving different international societies for rare immunological disorders.1009 patients diagnosed with MIS-C between March and September 2022, from 48 centers and 22 countries were collected. Five age groups (<1, 1-4, 5-11, 12-16, >16 years) and four geographic macro-areas, Western Europe, Central-Eastern Europe, Latin America, Asian-African resource-limited countries (LRC), were identified. RESULTS Time to referral was significantly higher in LRC. Intensive anti-inflammatory treatment, including biologics, respiratory support and mechanic ventilation were more frequently used in older children and in European countries. The mortality rate was higher in very young children (<1 year), in older patients (>16 years of age) and in LRC. Multivariate analysis identified the residence in LRC, presence of severe cardiac involvement, renal hypertension, lymphopenia and non-use of heparin prophylaxis, as the factors most strongly associated with unfavorable outcomes. CONCLUSIONS The stratification of patients by age and geographic macro-area provided insights into the clinical presentation, treatment and outcome of MIS-C. The mortality and sequelae rates exhibited a correlation with the age and geographical areas. Patients admitted and treated in LRC displayed more severe outcomes, possibly due to delays in hospital admission and limited access to biologic drugs and to intensive care facilities.
Collapse
Affiliation(s)
- Roberta Caorsi
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy; Università Degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genoa, Italy
| | - Camilla Speziani
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Betul Sozeri
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Kadir Ulu
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Enrique Faugier-Fuentes
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Hector Menchaca-Aguayo
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Seher Sener
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | | | - Mohammad Imnul Islam
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Paediatrics, Dhaka, Bangladesh
| | | | - Gabriele Simonini
- IRCCS Meyer Children's Hospital, Rheumatology Unit, ERN-ReCONNECT Center, Florence, Italy
| | - Mariel Viviana Mastri
- Hospital Interzonal de Agudos Especializado en Pediatría, Sor María Ludovica. Sala de Reumatologia La Plata, Argentina
| | - Tadej Avcin
- University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia
| | - Saša Sršen
- University Hospital Centre Split, Department of Pediatrics, Split, Croatia
| | | | - Valda Stanevicha
- Riga Stradins University, Children University Hospital, Riga, Latvia
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, University Clinical Center Nis, Clinic of Pediatrics, Department of Pediatric Rheumatology, Nis, Serbia
| | - Ali Sobh
- Mansoura University Children's Hospital, Faculty of Medicine Mansoura University, Mansura, Egypt
| | - Sarka Fingerhutova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Minxova
- University Hospital Hradec Kralove, Department of Pediatrics, Hradec Kralove, Czech Republic
| | - Alenka Gagro
- Children's Hospital Zagreb, Department of Pulmonology, Allergology, Clinical Immunology and Rheumatology, The University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adriana Rodrigues Fonseca
- Universidade Federal Do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Rio de Janeiro, Brazil
| | | | - Boriana Varbanova
- Varna Medical University, Department of Pediatrics First Pediatric Clinic, Varna, Bulgaria
| | - Judith Sánchez-Manubens
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - Margarita Ganeva
- University Children Hospital, Department of Paediatric Rheumatology, Sofia, Bulgaria
| | - Davide Montin
- Regina Margherita Children Hospital, Immunology and Rheumatology Unit, Turin, Italy
| | - Oksana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Department of Children's Diseases and Pediatric Surgery, Ternopil, Ukraine
| | - Andrea Minghini
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Claudia Bracaglia
- IRCCS Ospedale Pediatrico Bambino Gesù, Division of Rheumatology, Rome, Italy
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, UK
| | - Fabio Candotti
- Division of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Francesca Minoia
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Pediatria e Immunoreumatologia2 Milan, Italy
| | - Andrea Taddio
- Institute of Child and Maternal Health - IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy
| | - Carine Wouters
- UZ Leuven - Universitair Ziekenhuis, Leuven, Belgium; KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
| | | | - Francesca Bovis
- University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - Angelo Ravelli
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOC Servizio di Sperimentazioni Cliniche Pediatriche, PRINTO, Genoa, Italy
| | - Marco Gattorno
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy.
| | - Yelda Bilginer
- Hacettepe University Children's Hospital, Ankara, Turkey
| | - Kamrul Laila
- Bangabandhu Sheikh Mujib Medical Universit, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | - Oksana Chubata
- Ternopil Regional Children's Hospital, Ternopil, Ukraine
| | - Francesca Ricci
- Clinica Pediatrica Dell'Università di Brescia, Spedali Civili, Brescia, Italy
| | | | | | - Mojca Zajc Avramovic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Emersic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Masa Bizjak
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Vesel
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | - Eva Terifajova
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Martin Magner
- Thomayer University Hospital, Prague, Czech Republic
| | | | | | - Marija Jelusic
- University Hospital Centre Zagreb, University School of Medicine, Zagreb, Croatia
| | - Francesco La Torre
- Ospedale Pediatrico Giovanni XXIII - Azienda Ospedaliero-Universitaria Consorziale-Policlinico, Bari, Italy
| | | | | | | | - Nadina Rubio-Perez
- Hospital Universitario Dr. J. E. Gonzalez, Universidad, Autónoma de Nuevo León, Monterrey, NL, Mexico
| | | | | | | | | | - Ekaterina Alexeeva
- State Institution Scientific Center of Children Health of Rams Moscow, Moscow, Russian Federation
| | - Vyacheslav Chasnyk
- Saint-Petersburg State Pediatric Medical Academy, Saint-Petersburg, Russian Federation
| | | | - Yaryna Boyko
- Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Yulia Vyzhga
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | | |
Collapse
|
5
|
Uygun H, Varan C, Konca C, Erdem N, Kazaz TG, Turgut M. Should aortic stiffness parameters be used in MIS-C patient follow-up? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1525-1533. [PMID: 38748055 DOI: 10.1007/s10554-024-03133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/04/2024] [Indexed: 07/19/2024]
Abstract
We evaluated the short- and long-term effects of multisystem inflammatory syndrome in children (MIS-C) on their cardiovascular system. The study population consisted of 38 MIS-C patients and 55 control patients. Standard echocardiographic measurements and aortic stiffness parameters were compared between the two groups at different time points. During the standard echocardiographic examination at the time of diagnosis, mitral valve insufficiency was detected in 42% of the cases, left ventricular systolic dysfunction in 36%, aortic valve insufficiency in 3%, tricuspid valve insufficiency in 13%, and coronary artery dilatation in 31%. The ejection fraction, pulse pressure of the experimental group were significantly lower than the control group (p < 0.01, p = 0.045, respectively). When aortic stiffness parameters were compared, it was seen that the parameters increased in the experimental group and the difference was significant for aortic distensibility. (p = 0.105, p = 0.029 respectively). When comparing the experimental group's results at diagnosis and at the sixth month, there was a decrease in aortic stiffness parameters at the sixth month compared to the time of diagnosis, but the difference wasn't significant (p = 0.514, p = 0.334). However, no statistically significant difference was detected when comparing the aortic distensibility results of the experimental group with the control group at the sixth month (p = 0.667). Our results showed that many pathological echocardiographic findings detected at diagnosis in MIS-C patients returned to normal within six months. Therefore, we believe that the cardiovascular follow-up period of MIS-C cases should be at least six months.
Collapse
Affiliation(s)
- Hatice Uygun
- Department of Pediatric Infectious Disease, Gaziantep University School of Medicine, University Boulevard, Sehitkamil-Gaziantep, 27310, Turkey.
| | - Celal Varan
- Department of Pediatric Cardiology, Adana City Hospital, Adana, Turkey
| | - Capan Konca
- Department of Pediatric Intensive Care, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Nurettin Erdem
- Department of Pediatric Infectious Disease, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | | | - Mehmet Turgut
- Department of Pediatric Infectious Disease, School of Medicine, Adiyaman University, Adiyaman, Turkey
| |
Collapse
|
6
|
Sun YK, Wang C, Lin PQ, Hu L, Ye J, Gao ZG, Lin R, Li HM, Shu Q, Huang LS, Tan LH. Severe pediatric COVID-19: a review from the clinical and immunopathophysiological perspectives. World J Pediatr 2024; 20:307-324. [PMID: 38321331 PMCID: PMC11052880 DOI: 10.1007/s12519-023-00790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) tends to have mild presentations in children. However, severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times, meriting further attention from clinicians. Meanwhile, the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood. DATA SOURCES A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included "COVID-19 in children", "severe pediatric COVID-19", and "critical illness in children with COVID-19". RESULTS Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines. CONCLUSIONS Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
Collapse
Affiliation(s)
- Yi-Kan Sun
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310030, China
| | - Can Wang
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Pei-Quan Lin
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Lei Hu
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jing Ye
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Zhi-Gang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Ru Lin
- Department of Cardiopulmonary and Extracorporeal Life Support, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Hao-Min Li
- Clinical Data Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Qiang Shu
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
- National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Li-Su Huang
- National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
| | - Lin-Hua Tan
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
| |
Collapse
|
7
|
Lee S, Erdem G, Yasuhara J. Multisystem inflammatory syndrome in children associated with COVID-19: from pathophysiology to clinical management and outcomes. Minerva Pediatr (Torino) 2024; 76:268-280. [PMID: 37284807 DOI: 10.23736/s2724-5276.23.07205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome (PIMS), is a new postinfectious illness associated with COVID-19, affecting children after SARS-CoV-2 exposure. The hallmarks of this disorder are hyperinflammation and multisystem involvement, with gastrointestinal, cardiac, mucocutaneous, and hematologic disturbances seen most commonly. Cardiovascular involvement includes cardiogenic shock, ventricular dysfunction, coronary artery abnormalities, and myocarditis. Now entering the fourth year of the pandemic, clinicians have gained some familiarity with the clinical presentation, initial diagnosis, cardiac evaluation, and treatment of MIS-C. This has led to an updated definition from the Centers for Disease Control and Prevention in the USA driven by increased experience and clinical expertise. Furthermore, the available evidence established expert consensus treatment recommendations supporting a combination of immunoglobulin and steroids. However, the pathophysiology of the disorder and answers to what causes this remain under investigation. Fortunately, long-term outcomes continue to look promising, although continued follow-up is still needed. Recently, COVID-19 mRNA vaccination is reported to be associated with reduced risk of MIS-C, while further studies are warranted to understand the impact of COVID-19 vaccines on MIS-C. We review the findings and current literature on MIS-C, including pathophysiology, clinical features, evaluation, management, and medium- to long-term follow-up outcomes.
Collapse
Affiliation(s)
- Simon Lee
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guliz Erdem
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jun Yasuhara
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA -
- Center for Cardiovascular Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiology, Royal Children's Hospital, Parkville, Australia
| |
Collapse
|
8
|
McAree D, Hauck A, Arzu J, Carr M, Acevedo J, Patel AB, Husain N. Clinical Predictors of Subacute Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol 2024; 45:876-887. [PMID: 36260103 PMCID: PMC9580417 DOI: 10.1007/s00246-022-03021-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) often involves a post-viral myocarditis and associated left ventricular dysfunction. We aimed to assess myocardial function by strain echocardiography after hospital discharge and to identify risk factors for subacute myocardial dysfunction. We conducted a retrospective single-center study of MIS-C patients admitted between 03/2020 and 03/2021. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-ventricular circumferential strain (CS), and left atrial strain (LAS) were measured on echocardiograms performed 3-10 weeks after discharge and compared with controls. Among 60 MIS-C patients, hypotension (65%), ICU admission (57%), and vasopressor support (45%) were common, with no mortality. LVEF was abnormal (< 55%) in 29% during hospitalization but only 4% at follow-up. Follow-up strain abnormalities were prevalent (GLS abnormal in 13%, 4C-LS in 18%, CS in 16%, LAS in 5%). Hypotension, ICU admission, ICU and hospital length of stay, and any LVEF < 55% during hospitalization were factors associated with lower strain at follow-up. Higher peak C-reactive protein (CRP) was associated with hypotension, ICU admission, total ICU days, and with lower follow-up GLS (r = - 0.55; p = 0.01) and CS (r = 0.41; p = 0.02). Peak CRP < 18 mg/dL had negative predictive values of 100% and 88% for normal follow-up GLS and CS, respectively. A subset of MIS-C patients demonstrate subclinical systolic and diastolic function abnormalities at subacute follow-up. Peak CRP during hospitalization may be a useful marker for outpatient cardiac risk stratification. MIS-C patients with hypotension, ICU admission, any LVEF < 55% during hospitalization, or a peak CRP > 18 mg/dL may warrant closer monitoring than those without these risk factors.
Collapse
Affiliation(s)
- Daniel McAree
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Amanda Hauck
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Michael Carr
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Acevedo
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Ami B. Patel
- Department of Infectious Diseases, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Nazia Husain
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| |
Collapse
|
9
|
Jepson BM, Beaver M, Colquitt JL, Truong DT, Crandall H, McFarland C, Williams R, Ou Z, Jensen D, Minich LL, Binka E. Left Atrial Strain in Multisystem Inflammatory Syndrome in Children and Associations with Systemic Inflammation and Cardiac Injury. Pediatr Cardiol 2024; 45:729-739. [PMID: 38360919 DOI: 10.1007/s00246-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) commonly involves cardiac injury with both systolic and diastolic dysfunction. Left atrial strain (LAS) detects subclinical diastolic dysfunction in adults but is infrequently used in children. We evaluated LAS in MIS-C and the associations with systemic inflammation and cardiac injury. In this retrospective cohort study, LAS parameters [reservoir (LAS-r), conduit (LAS-cd), and contractile (LAS-ct)] obtained from admission echocardiograms of MIS-C patients were compared to healthy controls and between MIS-C patients with and without cardiac injury (BNP > 500 pg/ml or troponin-I > 0.04 ng/ml). Correlation and logistic regression analyses were performed to assess LAS associations with admission inflammatory and cardiac biomarkers. Reliability testing was performed. We identified 118 patients with MIS-C and 20 healthy controls. Median LAS parameters were reduced in MIS-C patients compared to controls (LAS-r: 31.8 vs. 43.1%, p < 0.001; LAS-cd: - 28.8 vs. - 34.5%, p = 0.006; LAS-ct: - 5.2 vs. - 9.3%, p < 0.001) and reduced in MIS-C patients with cardiac injury (n = 59) compared to no injury (n = 59) (LAS-r: 29.6 vs. 35.8%, p = 0.001; LAS-cd: - 26.5 vs. - 30.4%, p = 0.036; LAS-ct: - 4.6 vs. - 9.3%, p = 0.008). A discrete LAS-ct peak was absent in 65 (55%) MIS-C patients but present in all controls (p < 0.001). Procalcitonin correlated strongly with averaged E/e' (r = 0.55, p = 0.001). Moderate correlations were found for ESR and LAS-ct (r = - 0.41, p = 0.007) as well as BNP and LAS-r (r = - 0.39, p < 0.001) and LAS-ct (r = 0.31, p = 0.023). Troponin-I had only weak correlations. Intra-rater reliability was good for all LAS parameters, and inter-rater reliability was good to excellent for LAS-r, and fair for LAS-cd and LAS-ct. LAS analysis, particularly the absence of a LAS-ct peak, was reproducible and may be superior to conventional echocardiographic parameters for detecting diastolic dysfunction in MIS-C. No strain parameters on admission were independently associated with cardiac injury.
Collapse
Affiliation(s)
- Bryan M Jepson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
- Primary Children's Hospital Outpatient Services, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
| | - Matthew Beaver
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - John L Colquitt
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Dongngan T Truong
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Hillary Crandall
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carol McFarland
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Richard Williams
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Devri Jensen
- Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - L LuAnn Minich
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Locci C, Bassareo PP, Fanelli C, Maida I, Saderi L, Puci MV, Sotgiu G, Culeddu MC, Piga S, Oppo A, Antonucci R. Electrocardiography in Children Hospitalized for COVID-19 and Not Suffering from Multisystem Inflammatory Syndrome in Children (MIS-C): An Observational Study. J Cardiovasc Dev Dis 2024; 11:85. [PMID: 38535108 PMCID: PMC10971008 DOI: 10.3390/jcdd11030085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 05/14/2024] Open
Abstract
The risk of cardiac involvement with electrophysiological abnormalities during COVID-19 infection has been reported in adults but remains poorly studied in children. Our aim was to determine the frequency of cardiac involvement and the necessity of routine cardiac evaluation in children hospitalized for COVID-19. This observational study included 127 children, with a median (IQR) age of 2 (0.83-6.0) years, who were hospitalized for COVID-19 between 1 January 2021 and 31 August 2022, 62 (48.8%) of whom were males. Each patient underwent an ECG on admission and discharge as well as a laboratory assessment. A comparison between patients with COVID-19 and healthy controls showed significantly higher HR (p < 0.0001) and lower PR values (p = 0.02) in the first group. No arrhythmias or other electrocardiographic abnormalities were detected during hospitalization. The median levels of troponin, NT-proBNP, ferritin, and D-dimer were significantly higher in children aged <2 years, but they fell within the normal range for their age. Our results indicate that a detectable cardiac involvement is very rare in children hospitalized for COVID-19 and not suffering from Multisystem Inflammatory Syndrome in Children (MIS-C) and suggest that routine electrocardiographic assessment is not mandatory in these patients in the absence of cardiac symptoms/signs.
Collapse
Affiliation(s)
- Cristian Locci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children’s Health Ireland Crumlin, D07 R2WY Dublin, Ireland
| | - Chiara Fanelli
- Department of Infectious Diseases, University of Sassari, 07100 Sassari, Italy (I.M.)
| | - Ivana Maida
- Department of Infectious Diseases, University of Sassari, 07100 Sassari, Italy (I.M.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Chiara Culeddu
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy; (M.C.C.); (S.P.)
| | - Stefania Piga
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy; (M.C.C.); (S.P.)
| | - Antonella Oppo
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy; (M.C.C.); (S.P.)
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
11
|
Balkarlı E, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Yılmaz Çelebi M, Apa H, Meşe T, Ağın H, Bayram SN, Devrim İ. The evaluation of the burden of multisystem inflammatory syndrome in children on health economics. Arch Rheumatol 2024; 39:10-19. [PMID: 38774689 PMCID: PMC11104748 DOI: 10.46497/archrheumatol.2023.10147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives This study aimed to evaluate the diagnostic tests and treatments applied in patients with multisystem inflammatory syndrome in children (MIS-C) and to determine the effect of the disease on health costs. Patients and methods This retrospective cohort study included 59 MIS-C patients (40 males, 19 females; mean age: 7.7±4.2 years; range, 4 months to 16.5 years) who were admitted and treated between April 1, 2020, and November 1, 2021. Demographic and clinical features with hospital costs and length of stay were retrospectively reviewed from the medical files and computerized system of the hospital. Direct medical care costs of items were calculated with the hospital perspective using a combination of microcosting technique (resource-based accounting method) and hospital list data. Cases were classified as mild, moderate, or severe, and the patients were divided into two groups: the mild group and the moderate-severe group. Classification was determined by the vasoactive inotropic score (VIS), degree of respiratory support, and evidence of organ damage. Results The mean age of the cases in the mild group was 6.5±3.7 years, and the mean age of the cases in the moderate-severe group was 9.2±4.3 years. Of 59 patients, 19 (32.2%) were followed up in the pediatric intensive care unit. The median duration of hospitalization in the hospital was 8 (interquartile range: 7-12) days. The total cost of the patients hospitalized with the diagnosis of MIS-C during the study period was 849,242.93$, and the mean cost per patient was 14,393.94±9,631.92$. In the distribution of the total cost of hospitalization according to expenses, the highest rate was pharmacy and blood products (51.99%) and IVIG costs (43.99%). While the mean total cost per person was 13,682.87±8,799.63$ in mild cases, it was 16,433.82±9,440.02$ in moderate-severe cases, and no statistically significant relationship was found between the two groups (p>0.05). There was no difference in the mean cost per patient between the cases with and without heart, lung, kidney, or neurologic involvement and advanced respiratory support (p>0.05). There was a strong positive correlation between the total costs and age (r=0.883, n=59, p<0.0001), with increased amount of costs with increased age. Conclusion In the study, no statistically significant correlation was found between the total cost of per person in the mild group and the moderate-severe group (p>0.05). This finding may be due to the wide use of IVIG in MIS-C treatment, in addition to low transfer rates to pediatric intensive care units due to high-flow nasal cannula usage.
Collapse
Affiliation(s)
- Ezgi Balkarlı
- Department of Child Health and Diseases, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Türkiye
| | - Elif Kıymet
- Department of Pediatric Infectious Diseases, Batman Training and Research Hospital, Batman, Türkiye
| | - Elif Böncüoğlu
- Department of Pediatric Infectious Diseases, Konya City Hospital, Konya, Türkiye
| | - Şahika Şahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Miray Yılmaz Çelebi
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hurşit Apa
- Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Timur Meşe
- Department of Pediatric Cardiology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hasan Ağın
- Pediatric Intensive Care, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Süleyman Nuri Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| |
Collapse
|
12
|
Beaver M, Jepson B, Binka E, Truong D, Crandall H, McFarland C, Williams R, Ou Z, Treemarcki E, Jensen D, Minich LL, Colquitt JL. Baseline Echocardiography and Laboratory Findings in MIS-C and Associations with Clinical Illness Severity. Pediatr Cardiol 2024; 45:560-569. [PMID: 38281215 DOI: 10.1007/s00246-023-03394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024]
Abstract
Children with COVID-associated multisystem inflammatory syndrome (MIS-C) may develop severe disease. We explored the association of admission echocardiographic and laboratory parameters with MIS-C disease severity. This retrospective, single center study of consecutive MIS-C patients (4/2020-12/2021) excluded those with preexisting cardiomyopathy, congenital heart disease, or prior cardiotoxic therapy. Our hypothesis was that worse admission echocardiographic and laboratory parameters were associated with more severe disease based on vasoactive medication use. Univariable and multivariable logistic regression models assessed the association between vasoactive medication use and baseline variables. Of 118 MIS-C patients, median age was 7.8 years (IQR 4.6, 11.8), 48% received vasoactive medication. Higher admission brain natriuretic peptide [OR 1.07 (95% CI 1.02,1.14), p = 0.019], C-reactive protein [OR 1.08 (1.03,1.14), p = 0.002], troponin [OR 1.05 (1.02,1.1), p = 0.015]; lower left ventricular ejection fraction [LVEF, OR 0.96 (0.92,1), p = 0.042], and worse left atrial reservoir strain [OR 0.96 (0.92,1), p = 0.04] were associated with vasoactive medication use. Only higher CRP [OR 1.07 (1.01, 1.11), p = 0.034] and lower LVEF [0.91 (0.84,0.98), p = 0.015] remained independently significant. Among those with normal admission LVEF (78%, 92/118), 43% received vasoactive medication and only higher BNP [OR 1.09 (1.02,1.19), p = 0.021 per 100 pg/mL] and higher CRP [OR 1.07 (1.02,1.14), p = 0.013] were associated with use of vasoactive medication. Nearly half of all children admitted for MIS-C subsequently received vasoactive medication, including those admitted with a normal LVEF. Similarly, admission strain parameters were not discriminatory. Laboratory markers of systemic inflammation and cardiac injury may better predict early MIS-C disease severity.
Collapse
Affiliation(s)
- Matthew Beaver
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
- Primary Children's Hospital Outpatient Services, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
| | - Bryan Jepson
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Edem Binka
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Dongngan Truong
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Hillary Crandall
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Carol McFarland
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Richard Williams
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Erin Treemarcki
- Department of Pediatrics, Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Devri Jensen
- Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - L LuAnn Minich
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - John L Colquitt
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
13
|
Karagözlü S, Ramoğlu MG, Bayram Ö, Bakhtiyarzada J, Aydın A, Yılmaz MM, Murt B, Özkan E, İnceli HB, Gurbanov A, Şükriye Y, Demir B, Özdemir H, Çiftçi E, Kendirli T, Uçar T, Fitoz ÖS, Tutar E. Cardiovascular manifestations and cardiac magnetic resonance follow-up of multisystem inflammatory syndrome in children (MIS-C). Cardiol Young 2024; 34:291-300. [PMID: 37381829 DOI: 10.1017/s1047951123001348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE This study aimed to evaluate the cardiovascular manifestations and surveillance of multisystem inflammatory syndrome in children (MIS-C) and to determine the correlation of echocardiographic findings with cardiac magnetic resonance imaging findings. METHODS Forty-four children diagnosed as MIS-C with cardiac involvement were enrolled in this observational descriptive study. The diagnosis of MIS-C was made according to the criteria of Centers for Disease Control and Prevention. Clinical findings, laboratory parameters, and electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance was performed on 28 (64%) cases. The 1-year follow-up imaging was performed in all cases with abnormal initial cardiac magnetic resonance findings. RESULTS Forty-four patients (56.8% male) with a mean age of 8.5 ± 4.8 years were enrolled in this study. There was a significant positive correlation between high-sensitivity cardiac troponin T (mean: 162 ± 444.4 pg/ml) and N-terminal pro b-type natriuretic peptide (mean: 10,054 ± 11,604 pg/ml) (p < 0.01). Number of cases with an electrocardiographic and echocardiographic abnormality was 34 (77%) and 31 (70%), respectively. Twelve cases (45%) had left ventricular systolic dysfunction and 14 (32%) cases had pericardial effusion on admission. Three cases (11%) had cardiac magnetic resonance findings that may be attributed to the presence of myocardial inflammation, and pericardial effusion was present in seven (25%) cases. Follow-up cardiac magnetic resonances of all cases were normal. Cardiac abnormalities were completely resolved in all except two cases. CONCLUSIONS Myocardial involvement can be seen during acute disease, but MIS-C generally does not lead to prominent damage during a year of surveillance. Cardiac magnetic resonance is a valuable tool to evaluate the degree of myocardial involvement in cases with MIS-C.
Collapse
Affiliation(s)
- Selen Karagözlü
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet G Ramoğlu
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Özlem Bayram
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Jeyhun Bakhtiyarzada
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Alperen Aydın
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet Mustafa Yılmaz
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Begüm Murt
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Ersin Özkan
- Ankara University, School of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Hatice Belkıs İnceli
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Anar Gurbanov
- Ankara University, School of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Yılmaz Şükriye
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Berrin Demir
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Halil Özdemir
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ergin Çiftçi
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Tanıl Kendirli
- Ankara University, School of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Tayfun Uçar
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Ömer Suat Fitoz
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Ercan Tutar
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| |
Collapse
|
14
|
Almeida FJ, Jarovsky D, Almeida Farias CG, Ramos Nantes de Castilho TR, Gara Caetano T, Manzoni Ribeiro Borsetto CC, Simões Aguiar A, Serafini de Araújo C, Badue Pereira MF, de Sousa Marques HH, Silva CA, Ribeiro de Matos Tannure A, Prado R, Becker Mau L, Andrade Alvares P, de Siqueira AC, Paro Scremin G, Otsuka M, Volpe Arnoni M, Machado Rissoni Laporte R, Altruda de Moraes Costa Carlesse F, Ejzenberg F, Naaman Berezin E, Palazzi Sáfadi MA. High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil's Coronavirus Pandemic. Pediatr Infect Dis J 2024; 43:109-116. [PMID: 37991363 DOI: 10.1097/inf.0000000000004164] [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: 11/23/2023]
Abstract
BACKGROUND Brazil´s case fatality rate (CFR) of pediatric multisystem inflammatory syndrome in children and adolescents (MIS-C) is among the highest worldwide. Despite these concerns, limited hospital-based and comprehensive pediatric data have been published on MIS-C in Brazilian children. METHODS We performed a descriptive analysis of the MIS-C scores in 16 public and private hospitals providing secondary and tertiary care in the metropolitan area of São Paulo, Brazil. Clinical and demographic information were systematically extracted from the electronic medical records of each patient. Logistic regression analysis was performed to identify the combined effects of MIS-C phenotype, disease severity and comorbidity as dependent variables. RESULTS A total of 101 patients met the MIS-C criteria and were evaluated. The median age was 67 months, 60% were male, 28.7% were black or afrodescendant and 62.3% were admitted to public hospitals. Underlying medical conditions were observed in 16.8% of patients and were associated with a longer duration of hospitalization. A Kawasaki disease-like phenotype was observed in 43.5% of patients, and they demonstrated a trend of lower median age. Children with severe MIS-C were older (median age 91 months vs. 36 months) and had a nonspecific phenotype, more cardiovascular and respiratory involvement and kidney injury; 73.3% required intensive care, 20.8% required mechanical ventilation and 35.6% required inotropic support. Four deaths occurred (CFR = 3.9%), three of which were in healthy participants. CONCLUSION We identified a lower median age, particularly among children with Kawasaki disease-like phenotypes, those with a significant need for intensive care, and a high CFR in MIS-C. Our findings confirmed the increased severity of the disease in the selected Brazilian population.
Collapse
Affiliation(s)
- Flávia Jacqueline Almeida
- From the Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
| | - Daniel Jarovsky
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
| | - Camila Giuliana Almeida Farias
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital e Maternidade São Luiz Anália Franco, São Paulo, Brazil
- Department of Pediatrics, Hospital e Maternidade São Luiz São Caetano, São Caetano, Brazil
| | | | - Thiago Gara Caetano
- Department of Pediatrics, Hospital e Maternidade São Luiz São Caetano, São Caetano, Brazil
| | | | - Andressa Simões Aguiar
- Department of Pediatrics, Hospital São Luiz Gonzaga, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
| | | | - Maria Fernanda Badue Pereira
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Heloisa Helena de Sousa Marques
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Clovis Artur Silva
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | | - Rogério Prado
- Department of Pediatrics, Hospital Municipal do Tatuapé - Dr. Cármino Caricchio, São Paulo, Brazil
| | - Luciana Becker Mau
- Department of Pediatrics, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paula Andrade Alvares
- Department of Pediatrics, Hospital Municipal da Criança e do Adolescente de Guarulhos, Guarulhos, Brazil
| | | | | | - Marcelo Otsuka
- Department of Pediatrics, Hospital Infantil Darcy Vargas, São Paulo, Brazil
| | | | | | | | - Fernanda Ejzenberg
- Department of Pediatrics, Hospital Municipal M´Boi Mirim - Dr. Moysés Deutsch, São Paulo, Brazil
| | - Eitan Naaman Berezin
- From the Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marco Aurélio Palazzi Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
| |
Collapse
|
15
|
Herber JM, Bhumbra SS, Johansen MW, Slaven JE, Serrano RM. Cardiac injury in children with COVID-19. Cardiol Young 2024; 34:62-66. [PMID: 37190870 DOI: 10.1017/s1047951123000768] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is little known about the spectrum of cardiac injury in acute COVID-19 infection in children. METHODS A single-centre, retrospective chart analysis was performed. The protocol was deemed IRB exempt. All patients under the age of 21 years admitted from 20 March, 2020 to 22 June, 2021 for acute symptomatic COVID-19 infection or clinical suspicion of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were included. Past medical history, lab findings, echocardiogram and electrocardiogram/telemetry findings, and clinical outcomes were reviewed. RESULTS Sixty-six patients with MIS-C and 178 with acute COVID-19 were reviewed. Patients with MIS-C had more cardiac testing than those with acute COVID-19. Inflammatory markers were more likely elevated, and function was more likely abnormal on echocardiogram in those with MIS-C with testing performed. Among patients with MIS-C, 17% had evidence of coronary dilation versus 0% in the acute COVID-19 group. One (0.6%) patient with acute COVID-19 had clinically significant electrocardiogram or telemetry findings, and this was in the setting of prior arrhythmias and CHD. Four (6%) patients with MIS-C had clinically significant findings on electrocardiogram or telemetry. Among patients with acute COVID-19, extracorporeal membrane oxygenation support was required in 0.6% of patients with acute COVID-19, and there was a 2.8% mortality. There were no deaths in the setting of MIS-C. CONCLUSIONS Patients with acute COVID-19 and clinical suspicion of cardiac injury had a lower incidence of abnormal laboratory findings, ventricular dysfunction, or significant arrhythmia than those with MIS-C.
Collapse
Affiliation(s)
- Joshua M Herber
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
| | - Samina S Bhumbra
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Riley Hospital for Children, Indianapolis, IN, USA
| | - Michael W Johansen
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ryan M Serrano
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
| |
Collapse
|
16
|
Henderson LA. COVID-19-Related Multi-systemic Inflammatory Syndrome in Children (MIS-C). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:409-425. [PMID: 39117830 DOI: 10.1007/978-3-031-59815-9_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infections in children. This syndrome manifests about a month after the initial viral infection and is characterized by fever, multiorgan dysfunction, and systemic inflammation. This chapter will review the emergence, epidemiology, clinical characteristics, diagnosis, pathophysiology, immunomodulatory treatment, prognosis, outcomes, and prevention of MIS-C. While the pathophysiology of MIS-C remains to be defined, it is a post-infection, hyperinflammatory syndrome of childhood with elevated inflammatory cytokines.
Collapse
Affiliation(s)
- Lauren A Henderson
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
17
|
Tseng CT, Lin JJ, Huang JL, Chiu CH, Wu CY. Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study. Int J Rheum Dis 2024; 27:e14970. [PMID: 37947261 DOI: 10.1111/1756-185x.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious systemic inflammatory disorder that occurs following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to investigate the clinical manifestations, risk factors associated with pediatric intensive care unit (PICU) admission, and outcome among children with MIS-C in Taiwan. METHODS A retrospective analysis was conducted among pediatric patients diagnosed with MIS-C between June 2022 and February 2023 at Chang Gung Memorial Hospital, Linkou, Taiwan. Data on demographics, clinical features, laboratory findings, treatment modalities, and outcomes were collected and analyzed. RESULTS Twenty-eight MIS-C patients, including 9 boys and 19 girls, with an average age of 5.3 ± 3.8 years old, were enrolled. Most of the cases (78.6%) were diagnosed following the first pandemic wave of COVID-19 in Taiwan. The leading clinical manifestations observed were fever (100%), skin rash (64.3%), tachycardia (46.4%), and vomiting (46.4%). Nine patients (32.1%) were admitted to the PICU due to hypotension or neurological manifestations. Higher levels of band-form white blood cells, procalcitonin, ferritin, d-dimer, prothrombin time, NT-proBNP, and lower platelet levels on arrival were associated with PICU admission (p = 3.9 × 10-2 ,9 × 10-3 , 4 × 10-3 ,1 × 10-3 , 5 × 10-3 , 4.1 × 10-2 , and 3.4 × 10-2 , respectively). Arrhythmia in one case (3.5%) and coronary artery abnormalities, including dilatation in two cases (7.1%) and small aneurysms in one case (3.5%) were identified. Regardless of ICU admission, no patients experienced systolic dysfunction or mortality following treatment. CONCLUSION MIS-C cases in Taiwan have a favorable outcome. Although one-third of the patients required PICU admission, none of the MIS-C cases resulted in severe cardiovascular morbidity or mortality. This study provides valuable insights into the clinical manifestations and outcomes associated with PICU admission in children with MIS-C in Taiwan.
Collapse
Affiliation(s)
- Chi-Teng Tseng
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan city, Taiwan
| | - Jainn-Jim Lin
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan city, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan city, Taiwan
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan
- Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei city, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan city, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan city, Taiwan
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan
| |
Collapse
|
18
|
Begic Z, Djukic M, Begic E, Aziri B, Mladenovic Z, Iglica A, Sabanovic-Bajramovic N, Begic N, Kovacevic-Preradovic T, Stanetic B, Badnjevic A. Left atrial strain analysis in the realm of pediatric cardiology: Advantages and implications. Technol Health Care 2024; 32:1255-1272. [PMID: 37840514 DOI: 10.3233/thc-231087] [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] [Indexed: 10/17/2023]
Abstract
BACKGROUND Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.
Collapse
Affiliation(s)
- Zijo Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Milan Djukic
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim. Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Zorica Mladenovic
- Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Amer Iglica
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nirvana Sabanovic-Bajramovic
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nedim Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Almir Badnjevic
- Verlab Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina
- Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
19
|
Karas T, Scala M, Biebl A, Steiner J, Fellner F, Tulzer G, Tulzer A. Cardiac MRI six months after the onset of multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: A retrospective follow-up study. Cardiol Young 2024; 34:183-188. [PMID: 38031446 DOI: 10.1017/s1047951123004110] [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] [Indexed: 12/01/2023]
Abstract
BACKGROUND In 2020, reports revealed cases called multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 or multisystem inflammatory syndrome in children. A small proportion of patients suffer from persistent left ventricular dysfunction at discharge. The primary aim was to investigate if myocardial impairment persists during follow-up in these patients. METHODS Children fulfilling the criteria for multisystem inflammatory syndrome in children with cardiac involvement hospitalized between December 2020 and February 2022 were included in this retrospective single centre study. Cardiac MRI was performed six months after the onset of symptoms to evaluate possible persistent myocardial damage. RESULTS Fifteen patients (80% male) with a median age of 8 years (interquartile range 4.5 - 13.5 years) were included. Upon admission, eight patients (53%) presented with reduced left ventricular function, with a median left ventricular ejection fraction of 54% (interquartile range 49.5%-61.5%) on transthoracic echocardiography. Elevated levels of cardiac-specific markers were found in 14 patients (93%). Cardiac MRI was performed in 12 patients at a median of 190.5 days after the onset of symptoms. Nine patients (75%) had normal left ventricular function, with a median left ventricular ejection fraction of 59.45%, while the remaining patients showed mildly to moderately reduced values. None of the patients showed signs of late gadolinium enhancement, indicating the absence of persistent myocardial scarring. CONCLUSION During a follow-up of 6.2 months, mild to moderate cardiac impairment was revealed in 25% of patients evaluated by cardiac MRI. Although a majority of patients do not show signs of cardiac impairment, close follow-ups should be performed in a proportion of patients.
Collapse
Affiliation(s)
- Thomas Karas
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Mario Scala
- Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Ariane Biebl
- Department of Paediatrics, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Jürgen Steiner
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
| | - Franz Fellner
- Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Andreas Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| |
Collapse
|
20
|
Mileva N, Vasilev GH, Ganev B, Chervenkov L, Batselova H, Tzotcheva I, Tomov L, Velikova T, Lazova S. Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2175. [PMID: 38138278 PMCID: PMC10744581 DOI: 10.3390/medicina59122175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.
Collapse
Affiliation(s)
- Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Georgi H. Vasilev
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, “Plovdivsko pole” Str. No. 6, 1756 Sofia, Bulgaria;
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
| | - Borislav Ganev
- Pediatric Department, University Hospital N. I. Pirogov, 21 General Eduard I. Totleben blvd, 1606 Sofia, Bulgaria;
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, University Hospital “St George”, blvd. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Iren Tzotcheva
- Pediatric Clinic, UMHATEM “N. I. Pirogov”, Blvd. “General Eduard I. Totleben” 21, Pette Kyosheta, 1606 Sofia, Bulgaria;
| | - Latchezar Tomov
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
| | - Snezhina Lazova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
- Pediatric Clinic, UMHATEM “N. I. Pirogov”, Blvd. “General Eduard I. Totleben” 21, Pette Kyosheta, 1606 Sofia, Bulgaria;
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| |
Collapse
|
21
|
Zimmerman D, Shwayder M, Souza A, Su JA, Votava-Smith J, Wagner-Lees S, Kaneta K, Cheng A, Szmuszkovicz J. Cardiovascular Follow-up of Patients Treated for MIS-C. Pediatrics 2023; 152:e2023063002. [PMID: 37964674 DOI: 10.1542/peds.2023-063002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES To assess the prevalence of residual cardiovascular pathology by cardiac MRI (CMR), ambulatory rhythm monitoring, and cardiopulmonary exercise testing (CPET) in patients ∼6 months after multisystem inflammatory disease in children (MIS-C). METHODS Patients seen for MIS-C follow-up were referred for CMR, ambulatory rhythm monitoring, and CPET ∼6 months after illness. Patients were included if they had ≥1 follow-up study performed by the time of data collection. MIS-C was diagnosed on the basis of the Centers for Disease Control and Prevention criteria. Myocardial injury during acute illness was defined as serum Troponin-I level >0.05 ng/mL or diminished left ventricular systolic function on echocardiogram. RESULTS Sixty-nine of 153 patients seen for MIS-C follow-up had ≥1 follow-up cardiac study between October 2020-June 2022. Thirty-seven (54%) had evidence of myocardial injury during acute illness. Of these, 12 of 26 (46%) had ≥1 abnormality on CMR, 4 of 33 (12%) had abnormal ambulatory rhythm monitor results, and 18 of 22 (82%) had reduced functional capacity on CPET. Of the 37 patients without apparent myocardial injury, 11 of 21 (52%) had ≥1 abnormality on CMR, 1 of 24 (4%) had an abnormal ambulatory rhythm monitor result, and 11 of 15 (73%) had reduced functional capacity on CPET. The prevalence of abnormal findings was not statistically significantly different between groups. CONCLUSIONS The high prevalence of abnormal findings on follow-up cardiac studies and lack of significant difference between patients with and without apparent myocardial injury during hospitalization suggests that all patients treated for MIS-C warrant cardiology follow-up.
Collapse
Affiliation(s)
- Dayna Zimmerman
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Mark Shwayder
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew Souza
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer A Su
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jodie Votava-Smith
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sharon Wagner-Lees
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Kelli Kaneta
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Andrew Cheng
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jacqueline Szmuszkovicz
- Division of Cardiology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
22
|
Lehman JR, Schuchman M, Mitchell E, Capone CA, Sethna CB. Hypertension after multisystem inflammatory syndrome in children (MIS-C). Pediatr Nephrol 2023; 38:4083-4091. [PMID: 37422605 DOI: 10.1007/s00467-023-06061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/20/2023] [Accepted: 06/08/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is associated with SARS-CoV-2. Long-term consequences of MIS-C remain unknown. The objective was to describe the prevalence and clinical predictors of hypertension (HTN) and elevated blood pressure (BP) following MIS-C. METHODS A retrospective study of children ≤ 18 years admitted to a tertiary center with MIS-C was performed. HTN and elevated BP were classified as per the 2017 American Academy of Pediatrics Clinical Practice Guidelines and indexed to the 95th percentile. Data included demographics, inpatient clinical measures, and echocardiograms over 1-year follow-up. Data were analyzed using Kruskal-Wallis, chi-square, and logistic regression. RESULTS Among 63 children hospitalized with MIS-C (mean age 9.7 ± 4.2 years, 58.7% male, body mass index (BMI) z-score 0.59 ± 1.9), 14% had HTN, and 4% had elevated BP > 30 days post-hospitalization. Multivariate linear regression analysis showed that BMI z-score was significantly associated with higher mean systolic (β = 2.664, CI = 1.307-3.980, p < 0.001) and diastolic (β = 2.547, CI = 0.605-4.489, p = 0.012) BP index > 30 days post-hospitalization. Acute kidney injury (AKI) (23.8%) (OR = 2.977, CI = 1.778-4.987, p < 0.001), peak inpatient serum creatinine (OR = 2.524, CI = 1.344-4.740, p = 0.004), and maximum CRP (OR = 1.009, CI = 1.002-1.016, p = 0.014) were all associated with increased odds of post-hospitalization HTN. Left ventricular hypertrophy was present in 46% while hospitalized, compared to 10% at last follow-up. All had return of normal systolic function. CONCLUSIONS Post-hospitalization HTN and elevated BP may be associated with MIS-C. Children with greater BMI or AKI may be at greater risk for developing HTN after MIS-C. MIS-C follow-up requires careful BP monitoring and antihypertensive medication consideration. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Jake R Lehman
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Elizabeth Mitchell
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Christine A Capone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Christine B Sethna
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, 269-01 76th Avenue, NY, 11040, New Hyde Park, USA.
| |
Collapse
|
23
|
Mainzer G, Zucker-Toledano M, Hanna M, Bar-Yoseph R, Kodesh E. Significant exercise limitations after recovery from MIS-C related myocarditis. World J Pediatr 2023; 19:1149-1154. [PMID: 37127785 PMCID: PMC10150685 DOI: 10.1007/s12519-023-00722-w] [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: 07/22/2022] [Accepted: 03/30/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Myocarditis is one of the presentations of multisystemic inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). Although the reported short-term prognosis is good, data regarding medium-term functional capacity and limitations are scarce. This study aimed to evaluate exercise capacity as well as possible cardiac and respiratory limitations in children recovered from MIS-C related myocarditis. METHODS Fourteen patients who recovered from MIS-C related myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET), and their results were compared with an age-, sex-, weight- and activity level-matched healthy control group (n = 14). RESULTS All participants completed the CPET with peak oxygen uptake (peak [Formula: see text]), and the results were within the normal range (MIS-C 89.3% ± 8.9% and Control 87.9% ± 13.7% predicted [Formula: see text]). Five post-MIS-C patients (35%) had exercise-related cardio-respiratory abnormalities, including oxygen desaturation and oxygen-pulse flattening, compared to none in the control group. The MIS-C group also had lower peak exercise saturation (95.6 ± 3.5 vs. 97.6 ± 1.1) and lower breathing reserve (17.4% ± 7.5% vs. 27.4% ± 14.0% of MVV). CONCLUSIONS Patients who recovered from MIS-C related myocarditis may present exercise limitations. Functional assessment (e.g., CPET) should be included in routine examinations before allowing a return to physical activity in post-MIS-C myocarditis. Larger, longer term studies assessing functional capacity and focusing on physiological mechanisms are needed.
Collapse
Affiliation(s)
- Gur Mainzer
- Pediatric Heart Institute, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Pediatric Cardiology Department, Hadassah Medical Center, Jerusalem, Israel.
- Pediatric Cardiology Unit, Padeh Medical Center, Poriya, Israel.
| | - Merav Zucker-Toledano
- Pediatric Cardiology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Technion Faculty of Medicine, Haifa, Israel
| | - Einat Kodesh
- Pediatric Cardiology Unit, Padeh Medical Center, Poriya, Israel
- Department of Physical Therapy, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| |
Collapse
|
24
|
Yilmaz D, Ekemen Keles Y, Emiroglu M, Duramaz BB, Ugur C, Aldemir Kocabas B, Celik T, Ozdemir H, Bayturan S, Turel O, Erdeniz EH, Cakici O, Cakmak Taskin E, Erbas İC, Genceli M, Sari EE, Caymaz C, Kizil MC, Sutcu M, Demirbuga A, Alkan G, Bagcı Z, Timurtas Dayar G, Ozkan EA, Tekin Yilmaz A, Akca M, Yesil E, Kara SS, Akturk H, Yasar B, Umit Z, Uygun H, Erdem N, Buyukcam A, Karadag Oncel E, Tuter Oz SK, Cetin HS, Anil AB, Yilmaz R, Zengin N, Uzuner S, Albayrak H, Borakay O, Topal S, Arslan G, Yazar A, Ozer A, Kendirli T, Kara EM, Demirkol D, Battal F, Kosker M, Metin Akcan O, Kihtir HS, Gul D, Zararci K, Alakaya M, Kula N, Celik E, Petmezci E, Evren G, Kara Aksay A, Konca C, Sert A, Arslan D, Bornaun H, Tekeli O, Bal A, Sahin IO, Demir S, Sap F, Akyol MB, Tanidir IC, Donmez YN, Ucar T, Coban S, Arga G, Hancerli Torun S, Karpuz D, Celik SF, Varan C, Elmali F, Oncel S, Belet N, Hatipoglu N, Dalgic Karabulut N, Turgut M, Somer A, Kuyucu N, Dinleyici EC, Ciftci E, Kara A. Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study). Eur J Pediatr 2023; 182:5531-5542. [PMID: 37782350 DOI: 10.1007/s00431-023-05207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). METHODS This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. RESULTS A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. WHAT IS KNOWN • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. WHAT IS NEW • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.
Collapse
Affiliation(s)
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey.
| | | | | | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | - Talyan Celik
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Emine Ergul Sari
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Canan Caymaz
- Başakşehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | | | - Murat Sutcu
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Zafer Bagcı
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | | | | | - Belma Yasar
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Hatice Uygun
- Adıyaman Research and Training Hospital, Adiyaman, Turkey
| | | | - Ayse Buyukcam
- Ankara Gulhane Research and Training Hospital, Ankara, Turkey
| | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | | | | | - Ayse Berna Anil
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
- Pediatric Intensive Care, Health Sciences University Tepecik Training and Research Hospital, Izmir, Izmir, Turkey
| | | | | | - Selcuk Uzuner
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | - Sevgi Topal
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gazi Arslan
- Dokuz Eylül University Hospital, Izmir, Turkey
| | - Abdullah Yazar
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Arife Ozer
- Health Sciences University Van Training and Research Hospital, Van, Turkey
| | - Tanil Kendirli
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Intensive Care, Ankara University Hospital, Ankara, Turkey
| | | | | | - Fatih Battal
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | | | | | | | - Doruk Gul
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Nilgun Kula
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Elif Celik
- Aydin Adnan Menderes University Hospital, Aydin, Turkey
| | - Ercument Petmezci
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | - Capan Konca
- Adiyaman University Hospital, Adiyaman, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Derya Arslan
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Helen Bornaun
- Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Onur Tekeli
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Alkan Bal
- Celal Bayar University Hospital, Manisa, Turkey
| | | | - Selcan Demir
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Sap
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Mehmet Bedir Akyol
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | | | | | - Tayfun Ucar
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Cardiology, Ankara University Hospital, Ankara, Turkey
| | - Senay Coban
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Nevin Hatipoglu
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
| |
Collapse
|
25
|
Akkoyun EB, Most Z, Katragadda H, Yu A, Nassi L, Oakman N, Ginsburg S, Maamari M. Impact of anakinra use on clinical outcomes in children with moderate or severe multisystem inflammatory syndrome in children: a propensity score matched retrospective cohort study. Pediatr Rheumatol Online J 2023; 21:141. [PMID: 37996856 PMCID: PMC10666339 DOI: 10.1186/s12969-023-00924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The treatment of children with multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection involves immunomodulatory therapies such as IVIG and steroids. Anakinra, an interleukin-1 receptor inhibitor, has also been used, but its effectiveness is not established yet. As optimal regimens for MIS-C remain unknown, we aimed to assess the effect of anakinra in reducing hospital stay in patients with MIS-C. METHODS We included children admitted from May 2020 to May 2021 diagnosed with MIS-C based on CDC criteria. The exposure of interest was anakinra use at any point during admission. The anakinra exposed group and the anakinra unexposed group were propensity score matched based on demographic and clinical severity indicators at initial presentation. Our primary outcome was length of hospital stay. Secondary outcomes were duration of vasoactive support, vasoactive inotropic score (VIS), level of respiratory support, time to fever resolution, reduction of CRP levels, and length of ICU stay. We used Wilcoxon rank sum, t-test, Chi square and Fisher's exact tests. RESULTS Of 138 children diagnosed with MIS-C, 79% had moderate or severe illness and 41% received anakinra. Of those, 31 patients who received anakinra were propensity score matched to 31 who did not. The length of stay in the hospital but not in the ICU was longer in the anakinra group. There were no differences in median duration of vasoactive support, fever resolution, CRP reduction, or VIS. CONCLUSIONS In patients with moderate to severe MIS-C, use of anakinra was associated with longer duration of hospital stay.
Collapse
Affiliation(s)
- Esra B Akkoyun
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA.
- University of Texas Southwestern, Dallas, TX, USA.
| | - Zachary Most
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Harita Katragadda
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Andrew Yu
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Lorien Nassi
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Nicole Oakman
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Sarah Ginsburg
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| | - Mia Maamari
- Department of Pediatrics, Children's Medical Center, 1935 Medical District Dr. Dallas, Dallas, TX, USA
- University of Texas Southwestern, Dallas, TX, USA
| |
Collapse
|
26
|
Shehab N, English RF. Describing our experience with the effects of multisystem inflammatory syndrome in children with COVID-19 on the cardiovascular system. Cardiol Young 2023; 33:2312-2314. [PMID: 36720714 DOI: 10.1017/s1047951123000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cardiac involvement with multisystem inflammatory syndrome in children can include coronary artery abnormalities, ventricular dysfunction, conduction abnormalities, arrhythmias, pericarditis, and myocarditis. We report the cardiac findings in 34 patients with multisystem inflammatory syndrome in children admitted to a single institution. We looked at patient age, sex, brain natriuretic peptide levels, troponin levels, ejection fraction, presence of pericardial effusion, valvular changes, need for inotropic agents, and electrocardiogram findings. Our data showed that elevated brain natriuretic peptide did not predict troponin elevation and vice versa. Additionally, troponin rise was not a reliable marker for decreased left ventricular ejection fraction. All changes tracked were proven to be transient and resolved after initiating steroids, Intravenous immune globulin (IVIG), and occasionally anakinra.
Collapse
Affiliation(s)
- Norane Shehab
- Department of Pediatrics, UF Health Jacksonville, Jacksonville, FL 32209, USA
| | - Robert F English
- Department of Pediatric Cardiology, Baptist Medical Center, Wolfson Children's Hospital Terry Heart Institute, Jacksonville, FL 32207, USA
| |
Collapse
|
27
|
Le Guen C, Leroy E, Pennetier M, Launay É, Bichali S, Prot-Labarthe S. [Illustrated case study of a patient with pediatric multisystem inflammatory syndrome]. SOINS. PEDIATRIE, PUERICULTURE 2023; 44:42-47. [PMID: 37980161 DOI: 10.1016/j.spp.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Between November 2020 and June 2021, twelve children were treated at a university hospital in western France for pediatric multisystem inflammatory syndrome (PIMS). While the clinical presentation may have been reminiscent of Kawasaki disease, PIMS, a new nosological entity, was mentioned in the media in the context of the Covid-19 pandemic. In 2023, research into this syndrome will continue in France and Europe.
Collapse
Affiliation(s)
- Camille Le Guen
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France.
| | - Estelle Leroy
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Martine Pennetier
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Élise Launay
- Pédiatrie générale, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France; Faculté de médecine, université de Nantes, 1 rue Gaston-Veil, 44000 Nantes, France
| | - Saïd Bichali
- Maladies chroniques de l'enfant et unité de soins continus, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Sonia Prot-Labarthe
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France; Faculté de pharmacie, université de Nantes, 9 rue Bias, 44000 Nantes, France; Inserm U1123, Eceve, site Villemin, 10 avenue de Verdun, 75010 Paris, France
| |
Collapse
|
28
|
Carmona CA, Kuziez M, Freitas CF, Cyrus JW, Bain J, Karam O. Cardiac manifestations of multisystem inflammatory syndrome of children after SARS-CoV-2 infection: a systematic review and meta-analysis. Cardiol Young 2023; 33:2319-2327. [PMID: 36762563 DOI: 10.1017/s104795112300015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This systematic review and meta-analysis were conducted to evaluate the prevalence of cardiac manifestations associated with multisystem inflammatory syndrome in children worldwide. We conducted electronic searches in Ovid MEDLINE, Ovid EMBASE, and the World Health Organization COVID-19 Literature Database from the inception of the SARS-CoV-2 pandemic to 1 January, 2022. Three authors independently screened the abstracts to determine eligibility, assessed methodology in the full texts, and extracted the data.We identified 2848 citations; 94 studies (14,932 patients) were included. The prevalence of vasopressors was 48.2% (95% CI 45.1%, 51.3%), left ventricular systolic dysfunction occurred in 37.2% (95% CI 34.1%, 40.3%), myocarditis in 34.1% (95% CI 30.5%, 37.8%), electrocardiographic dysrhythmias and abnormalities detected in 23.1% (95% CI 18.8%, 27.6%), coronary abnormalities identified in 18% (95% CI 16%, 20%), extracorporeal membrane oxygenation deployed in 2.2% (95% CI 1.7%, 2.8%), and mortality rate of 2.2% (95% CI 1.7%, 2.7%). A sensitivity analysis was performed after removing eleven studies with high bias, and the adjusted prevalence was not different than the original evaluation.In this meta-analysis of the largest cohort of multisystem inflammatory syndrome in children patients to date, we established the most accurate prevalence of the most common cardiac manifestations. Providers will subsequently have more precise data to anticipate patient outcomes and approach discussions concerning the frequency of monitoring outside the acute hospital period.
Collapse
Affiliation(s)
- Carlos A Carmona
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Mohamed Kuziez
- Division of Pediatric Cardiology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Caio F Freitas
- Division of Pediatrics, Advent Health for Children, Pediatrics Residency, Orlando, FL, USA
| | - John W Cyrus
- Tompkins-McCaw Library for the Health Sciences, VCU Libraries, Virginia Commonwealth University, Richmond, VA, USA
| | - Jesse Bain
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
29
|
Broberg MC, Mazer MB, Cheifetz IM. Cardiovascular effects of COVID-19 in children. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:533-541. [PMID: 38920204 DOI: 10.47102/annals-acadmedsg.202386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Although severe acute respiratory failure is the primary cause of morbidity and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, this viral infection leads to cardiovascular disease in some individuals. Cardiac effects of the virus include myocarditis, pericarditis, arrhythmias, coronary aneurysms and cardiomyopathy, and can result in cardiogenic shock and multisystem organ failure. Method This review summarises cardiac manifesta-tions of SARS-CoV-2 in the paediatric population. We performed a scoping review of cardiovascular disease associated with acute coronavirus disease 2019 (COVID-19) infection, multisystem inflammatory syndrome in children (MIS-C), and mRNA COVID-19 vaccines. Also examined are special considerations for paediatric athletes and return to play following COVID-19 infection. Results Children presenting with acute COVID-19 should be screened for cardiac dysfunction and a thorough history should be obtained. Further cardiovascular evaluation should be considered following any signs/symptoms of arrhythmias, low cardiac output, and/or myopericarditis. Patients admitted with severe acute COVID-19 should be monitored with continuous cardiac monitoring. Laboratory testing, as clinically indicated, includes tests for troponin and B-type natriuretic peptide or N-terminal pro-brain natriuretic peptide. Echocardiography with strain evaluation and/or cardiac magnetic resonance imaging should be considered to evaluate diastolic and systolic dysfunction, coronary anatomy, the pericardium and the myocardium. For patients with MIS-C, combination therapy with intravenous immunoglobulin and glucocorticoid therapy is safe and potentially disease altering. Treatment of MIS-C targets the hyperimmune response. Supportive care, including mechanical support, is needed in some cases. Conclusion Cardiovascular disease is a striking feature of SARS-CoV-2 infection. Most infants, children and adolescents with COVID-19 cardiac disease fully recover with no lasting cardiac dysfunction. However, long-term studies and further research are needed to assess cardiovascular risk with variants of SARS-CoV-2 and to understand the pathophysiology of cardiac dysfunction with COVID-19.
Collapse
Affiliation(s)
- Meredith Cg Broberg
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Monty B Mazer
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Ira M Cheifetz
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| |
Collapse
|
30
|
Kumar NP, Venkataraman A, Nancy A, Selvaraj N, Moideen K, Ahamed SF, Renji RM, Sasidaran K, Kumar S, Periyakuppan M, Sangaralingam T, Varadarajan P, Chelladurai E, Babu S. Immune Profiles in Multisystem Inflammatory Syndrome in Children with Cardiovascular Abnormalities. Viruses 2023; 15:2162. [PMID: 38005840 PMCID: PMC10674423 DOI: 10.3390/v15112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), a sequela of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV2), has been progressively reported worldwide, with cardiac involvement being a frequent presentation. Although the clinical and immunological characteristics of MIS-C with and without cardiac involvement have been described, the immunological differences between cardiac and non-cardiac MIS-C are not well understood. METHODS The levels of type 1, type 2, type 17, other proinflammatory cytokines and CC chemokines and CXC chemokines were measured using the Magpix multiplex cytokine assay system in MIS-C children with MIS-C cardiac (MIS-C (C) (n = 88)) and MIS-C non-cardiac (MIS-C (NC) (n = 64)) abnormalities. RESULTS MIS-C children with cardiac manifestations presented with significantly increased levels of cytokines such as IFN-γ, IL-2, TNFα, IL-5, IL-1α, IL-1β, IL-6, IL-10 and IL-12p70 and chemokines such as CCL2, CCL3, CCL11 and CXCL10 in comparison to MIS-C children without cardiac manifestations. Clustering analysis revealed that cytokines and chemokines could clearly distinguish MIS-C children with and without cardiac manifestations. In addition, these responses significantly diminished and normalized 9 months after treatment. CONCLUSIONS This is one of the first studies characterizing and differentiating systemic inflammation in MIS-C with and without cardiac involvement from a low- and middle-income country (LMIC). Our study contributes to the existing body of evidence and advances our knowledge of the immunopathogenesis of MIS-C in children.
Collapse
Affiliation(s)
- Nathella Pavan Kumar
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Aishwarya Venkataraman
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Arul Nancy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Nandhini Selvaraj
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kadar Moideen
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Shaik Fayaz Ahamed
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Rachel Marriam Renji
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kandasamy Sasidaran
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | - Sandip Kumar
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | | | | | - Poovazhagi Varadarajan
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Elilarasi Chelladurai
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
31
|
Conti F, Moratti M, Leonardi L, Catelli A, Bortolamedi E, Filice E, Fetta A, Fabi M, Facchini E, Cantarini ME, Miniaci A, Cordelli DM, Lanari M, Pession A, Zama D. Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use. Cells 2023; 12:2417. [PMID: 37830631 PMCID: PMC10572613 DOI: 10.3390/cells12192417] [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: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The large-scale utilization of immunoglobulins in patients with inborn errors of immunity (IEIs) since 1952 prompted the discovery of their key role at high doses as immunomodulatory and anti-inflammatory therapy, in the treatment of IEI-related immune dysregulation disorders, according to labelled and off-label indications. Recent years have been dominated by a progressive imbalance between the gradual but constant increase in the use of immunoglobulins and their availability, exacerbated by the SARS-CoV-2 pandemic. OBJECTIVES To provide pragmatic indications for a need-based application of high-dose immunoglobulins in the pediatric context. SOURCES A literature search was performed using PubMed, from inception until 1st August 2023, including the following keywords: anti-inflammatory; children; high dose gammaglobulin; high dose immunoglobulin; immune dysregulation; immunomodulation; immunomodulatory; inflammation; intravenous gammaglobulin; intravenous immunoglobulin; off-label; pediatric; subcutaneous gammaglobulin; subcutaneous immunoglobulin. All article types were considered. IMPLICATIONS In the light of the current imbalance between gammaglobulins' demand and availability, this review advocates the urgency of a more conscious utilization of this medical product, giving indications about benefits, risks, cost-effectiveness, and administration routes of high-dose immunoglobulins in children with hematologic, neurologic, and inflammatory immune dysregulation disorders, prompting further research towards a responsible employment of gammaglobulins and improving the therapeutical decisional process.
Collapse
Affiliation(s)
- Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Mattia Moratti
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Lucia Leonardi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Arianna Catelli
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Elisa Bortolamedi
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Emanuele Filice
- Department of Pediatrics, Maggiore Hospital, 40133 Bologna, Italy;
| | - Anna Fetta
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Facchini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Maria Elena Cantarini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Daniele Zama
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| |
Collapse
|
32
|
Slöcker Barrio M, Belda Hofheinz S, Guitart Pardellans C, García-Salido A, de Carlos Vicente JC, Cuervas-Mons Tejedor M, Hernández Yuste A, Jiménez Olmos A, Morteruel Arizcuren E, García-Besteiro M, Calvo Monge C, Rodríguez Rubio M, Roca Pascual D, Bermúdez Barrezueta L, Martínez Padilla C, Huidobro Labarga B, Oulego-Erroz I, Sanchíz Cárdenas S, Rey Galan C, Holanda Peña MS, González Navarro P, Cortés RG. Characteristics and management of patients with SARS-CoV2 infection admitted to pediatric intensive care units: Data analysis of the Spanish national multicenter registry. Pediatr Pulmonol 2023; 58:2916-2929. [PMID: 37493137 DOI: 10.1002/ppul.26613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/29/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION The purpose of this study is to describe the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) disease characteristics and management in children admitted to the pediatric intensive care units (PICU). METHODS The present study was based on a national multicentric prospective registry including PICU patients with SARS-CoV2 infection or symptoms of multisystem inflammatory syndrome in children (MIS-C). RESULTS A total of 298 patients were admitted to 41 different Spanish PICUs. A total of 76% of them were previously healthy. The most frequent manifestation was MIS-C (69.8%). On admission, 59.4% of patients did not have respiratory distress, and only 17.4% needed conventional mechanical ventilation (MV). The need for MV was associated with age (incidence rate ratios [IRR] 1.21, p < .012), pediatric sequential organ failure assessment score (p-SOFA) Score (IRR 1.12, p = .001), and need for transfusion (IRR 4.5, p < .004) in MIS-C patients, and with vasoactive drug use (IRR 2.73, p = .022) and the diagnosis of acute respiratory distress syndrome (IRR 2.83, p = .018) in patients admitted for other reasons. During the first day of admission, 56% of patients met shock criteria and 50.7% needed vasoactive drugs. In MIS-C patients, their use was associated with higher p-SOFA score (IRR 1.06, p < .001) and with the diagnosis of shock (IRR 5.78, p < .001). In patients without MIS-C, it was associated with higher p-SOFA score (IRR 1.05, p = .022). The mortality rate was 3%, being lower in MIS-C patients compared to patients admitted for other reasons (0.5% vs. 9.4%, p < .001). It was also lower in previously healthy patients compared to patients with previous comorbidities (0.9% vs. 9.7%, p < .001). CONCLUSIONS Severe SARS-CoV2 infection is uncommon in the pediatric population. In our series, respiratory distress was rare, being MIS-C the most frequent cause of PICU admission related to SARS-CoV2. In most cases, the course of the disease was mild except in children with previous diseases.
Collapse
Affiliation(s)
- María Slöcker Barrio
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Public Health and Maternal and Child Department, Complutense University of Madrid, Madrid, Spain
| | - Sylvia Belda Hofheinz
- Public Health and Maternal and Child Department, Complutense University of Madrid, Madrid, Spain
- Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | - Ainhoa Jiménez Olmos
- Pediatric Intensive Care Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Cristina Calvo Monge
- Pediatric Intensive Care Unit, Hospital Universitario Donostia, San Sebastián, Spain
| | | | - David Roca Pascual
- Pediatric Intensive Care Unit, Campus Hospitalario Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Ignacio Oulego-Erroz
- Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Sonia Sanchíz Cárdenas
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Corsino Rey Galan
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Pablo González Navarro
- Methodology and Biostatistics Unit, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Rafael González Cortés
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Public Health and Maternal and Child Department, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
33
|
Arora R, Sethuraman U, Merolla DM, Sanil Y, Bharadwaj M, Kannikeswaran N. Efficacy of Biomarkers in Identifying Abnormal Echocardiogram in Multisystem Inflammatory Syndrome in Children. Clin Pediatr (Phila) 2023; 62:908-913. [PMID: 36585758 DOI: 10.1177/00099228221145271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiac involvement in multisystem inflammatory syndrome in children (MIS-C) is common and contributes to significant morbidity and mortality. We evaluated the efficacy of cardiac biomarkers in detection of an abnormal echocardiogram in MIS-C patients. A retrospective chart review of children ≤18 years diagnosed with MIS-C at our hospital was performed. Sensitivity and specificity of high-sensitivity troponin I (hs-TnI) and B-type natriuretic peptide (BNP) were estimated for an abnormal echocardiogram. Of the 83 patients with MIS-C, 33 (39.8%) had an abnormal echocardiogram. While BNP was more sensitive, hs-TnI >50 ng/L was more specific for detecting an abnormal echocardiogram. Compared with children who had normal hs-TnI levels (<17 ng/L), those with hs-TnI >50 ng/L were more likely to have an echocardiographic abnormality (relative risk: 4.9; 95% CI, 2.9-10.9). Children with abnormal BNP and/or troponin (especially greater than 3-fold the upper limit of normal) would benefit from an urgent echocardiogram in the emergency department.
Collapse
Affiliation(s)
- Rajan Arora
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Usha Sethuraman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - David M Merolla
- Department of Sociology, Wayne State University, Detroit, MI, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Madhumithaa Bharadwaj
- Pediatric Residency Program, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Nirupama Kannikeswaran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| |
Collapse
|
34
|
Ahmed IS, Tapponi SL, Widatallah ME, Alakkad YM, Haider M. Unmasking the enigma: An in-depth analysis of COVID-19 impact on the pediatric population. J Infect Public Health 2023; 16:1346-1360. [PMID: 37433256 PMCID: PMC10299956 DOI: 10.1016/j.jiph.2023.06.017] [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: 05/26/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES COVID-19, caused by the novel coronavirus, has had a profound and wide-reaching impact on individuals of all age groups across the globe, including children. This review article aims to provide a comprehensive analysis of COVID-19 in children, covering essential topics such as epidemiology, transmission, pathogenesis, clinical features, risk factors, diagnosis, treatment, vaccination, and others. By delving into the current understanding of the disease and addressing the challenges that lie ahead, this article seeks to shed light on the unique considerations surrounding COVID-19 in children and contribute to a deeper comprehension of this global health crisis affecting our youngest population. METHODS A comprehensive literature search was conducted to gather the most recent and relevant information regarding COVID-19 in children. Multiple renowned databases, including MEDLINE, PubMed, Scopus, as well as authoritative sources such as the World Health Organization (WHO), the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the National Institutes of Health (NIH) websites and others were thoroughly searched. The search included articles, guidelines, reports, clinical trials results and expert opinions published within the past three years, ensuring the inclusion of the latest research findings on COVID-19 in children. Several relevant keywords, including "COVID-19," "SARS-CoV-2," "children," "pediatrics," and related terms were used to maximize the scope of the search and retrieve a comprehensive set of articles. RESULTS AND CONCLUSION Three years since the onset of the COVID-19 pandemic, our understanding of its impact on children has evolved, but many questions remain unanswered. While SAR-CoV-2 generally leads to mild illness in children, the occurrence of severe cases and the potential for long-term effects cannot be overlooked. Efforts to comprehensively study COVID-19 in children must continue to improve preventive strategies, identify high-risk populations, and ensure optimal management. By unraveling the enigma surrounding COVID-19 in children, we can strive towards safeguarding their health and well-being in the face of future global health challenges.
Collapse
Affiliation(s)
- Iman Saad Ahmed
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Sara Luay Tapponi
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Marwa Eltahir Widatallah
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Yumna Mohamed Alakkad
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mohamed Haider
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| |
Collapse
|
35
|
Mohammadi H, Fereidooni R, Mehdizadegan N, Amoozgar H, Naghshzan A, Edraki MR, Tavangar A. Q wave in paediatric myocarditis: an underinvestigated, readily available prognostic factor. Acta Cardiol 2023; 78:813-822. [PMID: 36534013 DOI: 10.1080/00015385.2022.2148896] [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: 08/10/2022] [Revised: 10/02/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myocarditis is an uncommon disease in children with potentially fatal consequences. An electrocardiogram (ECG) change seen in myocarditis is pathological Q wave. Pathological Q wave is linked to permanent damage and myocardial death in several cardiac diseases. We investigated the significance of pathological Q waves in children with acute myocarditis (AM). METHODS This retrospective observational study analysed the data of 59 children with AM admitted to our hospital between January 2016 and July 2021. They were divided into Q wave and non-Q wave myocarditis groups. Patients' laboratory data, echocardiography, treatment and hospital outcome were analysed. RESULTS Patients were 64.4% male and had a median age of 6 years and 9 months. Pathological Q waves were found in 52.5% of the patients. Q wave myocarditis group had higher troponin I values (499 vs. 145 ng/L, p = 0.011) and longer hospital stays (13 vs. 9 days, p = 0.020) than the non-Q wave group. They also required higher doses of inotropic or vasoactive drugs. 61.3% of Q wave patients needed mechanical ventilation compared to 35.7% of non-Q wave patients (p = 0.069). All the patients who died or discharged with an LVEF < 30% belonged to the Q wave group. CONCLUSION Q wave in AM warrants close monitoring and intensive treatment as it accompanies more severe complications and poorer outcomes. This readily available ECG finding can be a clue to prognoses of AM patients. Further research with larger populations is needed to better understand Q wave prognostic accuracy and its potential role in guiding more expensive treatments.
Collapse
Affiliation(s)
- Hamid Mohammadi
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Mehdizadegan
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Naghshzan
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Edraki
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirali Tavangar
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
36
|
Pannu AK, Singla V, Suri V, Kumar R, Mathur Y, Mohindra R, Jain S. Adult-onset Still's disease and fever of unknown origin in India. Clin Exp Med 2023; 23:1659-1666. [PMID: 36178600 PMCID: PMC9523624 DOI: 10.1007/s10238-022-00903-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
Despite an essential differential diagnosis for fever of unknown origin (FUO) in young adults, adult-onset Still's disease (AOSD) is infrequently considered and remained underdiagnosed in low-middle-income countries. The present study analyzed the clinical, serological, radiological, and pathological characteristics of AOSD presented as FUO in India. A hospital-based retrospective study of patients aged > 13 years admitted with FUO and later diagnosed with AOSD in Postgraduate Institute of Medical Education and Research, Chandigarh (India), was conducted between January 2014 and December 2020. Petersdorf and Beeson's criteria were used to define FUO. The diagnosis of AOSD was made based on Yamaguchi's criteria. Twenty-seven patients (median age 26 years, 14 females) were enrolled. All presented with intermittent fever with a median duration of 10 weeks. The typical features of AOSD at admission were arthralgia (n = 24), hepatosplenomegaly (n = 21), spiking fever ≥ 39 °C (n = 19), lymphadenopathy (n = 18), typical rash (n = 17), and sore throat (n = 11). Leukocytosis (n = 25) and neutrophilia (n = 19) were frequent. Hyperferritinemia was universal (range, 700-145,003 ng/ml; ≥ 2000, n = 23). At admission, AOSD was suspected in only nine FUO cases, while tuberculosis (n = 16), undifferentiated connective tissue disorder (n = 14), and lymphoproliferative disorder (n = 11) were common diagnostic possibilities. Crispin et al. clinical scale detected AOSD in only 15 (55.5%) FUO patients. Whole-body imaging (n = 27), including fluorodeoxyglucose positron emission tomography (n = 12), demonstrated reticuloendothelial organ-system involvement and serositis. Seventeen (63%) patients had macrophage activation syndrome at the time of AOSD diagnosis. AOSD FUO presents with typical but nonspecific features; thus, early differentiation from common causes (e.g., tuberculosis, lymphoma) is difficult. Macrophage activation syndrome is common in AOSD with FUO presentation.
Collapse
Affiliation(s)
- Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Vidhi Singla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, Chandigarh, 160012 India
| | - Yamini Mathur
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, Chandigarh, 160012 India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| |
Collapse
|
37
|
De Wolf R, Zaqout M, Tanaka K, Muiño-Mosquera L, van Berlaer G, Vandekerckhove K, Dewals W, De Wolf D. Evaluation of late cardiac effects after multisystem inflammatory syndrome in children. Front Pediatr 2023; 11:1253608. [PMID: 37691776 PMCID: PMC10484557 DOI: 10.3389/fped.2023.1253608] [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: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Multisystem inflammatory syndrome in children (MIS-C) is associated with important cardiovascular morbidity during the acute phase. Follow-up shows a swift recovery of cardiac abnormalities in most patients. However, a small portion of patients has persistent cardiac sequelae at mid-term. The goal of our study was to assess late cardiac outcomes of MIS-C. Methods A prospective observational multicenter study was performed in children admitted with MIS-C and cardiac involvement between April 2020 and March 2022. A follow-up by NT-proBNP measurement, echocardiography, 24-h Holter monitoring, and cardiac MRI (CMR) was performed at least 6 months after MIS-C diagnosis. Results We included 36 children with a median age of 10 (8.0-11.0) years, and among them, 21 (58%) were girls. At diagnosis, all patients had an elevated NT-proBNP, and 39% had a decreased left ventricular ejection fraction (LVEF) (<55%). ECG abnormalities were present in 13 (36%) patients, but none presented with arrhythmia. Almost two-thirds of patients (58%) had echocardiographic abnormalities such as coronary artery dilation (20%), pericardial effusion (17%), and mitral valve insufficiency (14%). A decreased echocardiographic systolic left ventricular (LV) function was detected in 14 (39%) patients. A follow-up visit was done at a mean time of 12.1 (±5.8) months (range 6-28 months). The ECG normalized in all except one, and no arrhythmias were detected on 24-h Holter monitoring. None had persistent coronary artery dilation or pericardial effusion. The NT-proBNP level and echocardiographic systolic LV function normalized in all patients, except for one, who had a severely reduced EF. The LV global longitudinal strain (GLS), as a marker of subclinical myocardial dysfunction, decreased (z < -2) in 35%. CMR identified one patient with severely reduced EF and extensive myocardial fibrosis requiring heart transplantation. None of the other patients had signs of myocardial scarring on CMR. Conclusion Late cardiac outcomes after MIS-C, if treated according to the current guidelines, are excellent. CMR does not show any myocardial scarring in children with normal systolic LV function. However, a subgroup had a decreased GLS at follow-up, possibly as a reflection of persistent subclinical myocardial dysfunction.
Collapse
Affiliation(s)
- Rik De Wolf
- Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Mahmoud Zaqout
- Department of Pediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Pediatric Cardiology, ZNA Queen Paola Children’s Hospital, Antwerp, Belgium
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | | | - Gerlant van Berlaer
- Department of Pediatric Intensive Care, University Hospital Brussels, Brussels, Belgium
| | | | - Wendy Dewals
- Department of Pediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Daniël De Wolf
- Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
38
|
Roge I, Kivite-Urtane A, Smane L, Meiere A, Klavina L, Barzdina E, Pavare J. Short- and mid-term outcomes of multisystem inflammatory syndrome in children: a longitudinal prospective single-center cohort study. Front Pediatr 2023; 11:1223266. [PMID: 37650048 PMCID: PMC10465300 DOI: 10.3389/fped.2023.1223266] [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: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-c) emerged during the coronavirus disease 2019 pandemic and is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the extensively studied clinical manifestation of acute condition, the short- and long-term effects of MIS-c on children's health are unknown. Methods This was a prospective longitudinal cohort study. Children aged <18 years who met the Centers for Disease Prevention and Control (CDC) diagnostic criteria and who were admitted to the Children's Clinical University Hospital of Latvia (CCUH) between July 1, 2020, and April 15, 2022, were enrolled in the study. An outpatient follow-up program was initiated in July 2020. All children were evaluated at 2 weeks, 2 months (1-3 months), and 6 months (5-7 months) after discharge. The face-to-face interviews comprised four domains as follows: symptom assessment, physical examination, laboratory testing, and cardiological investigation [including electrocardiogram (ECG) and echocardiography (echo)]. Results Overall, 21 patients with MIS-c were enrolled. The median age of the study group was 6 years. At the 2-week follow-up, almost half of the patients (N = 10, 47.6%) reported exercise intolerance with provoked tiredness. Laboratory tests showed a considerable increase in blood cell count, with a near doubling of leukocyte and neutrophil counts and a tripling of thrombocyte levels. However, a decline in the levels of inflammatory and organ-specific markers was observed. Cardiological investigation showed significant improvement with gradual resolution of the acute-phase pathological findings. Within 2 months, improvement in exercise capacity was observed with 5-fold and 2-fold reductions in physical intolerance (N = 2, 9.5%) and physical activity-induced fatigue (N = 5, 23.8%), respectively. Normalization of all blood cell lines was observed, and cardiological investigation showed no persistent changes. At the 6-month visit, further improvement in the children's exercise capacity was observed, and both laboratory and cardiological investigation showed no pathological changes. Conclusions Most persistent symptoms were reported within the first 2 weeks after the acute phase, with decreased physical activity tolerance and activity-induced fatigue as the main features. A positive trend was observed at each follow-up visit as the spectrum of the children's complaints decreased. Furthermore, rapid normalization of laboratory markers and cardiac abnormalities was observed.
Collapse
Affiliation(s)
- Ieva Roge
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Anda Kivite-Urtane
- Department of Public Health and Epidemiology, Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Liene Smane
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Anija Meiere
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Lizete Klavina
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Elza Barzdina
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | - Jana Pavare
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| |
Collapse
|
39
|
Avrusin IS, Abramova NN, Belozerov KE, Kondratiev GV, Bregel LV, Efremova OS, Vilnits AA, Konstantinova JE, Isupova EA, Kornishina TL, Masalova VV, Felker EY, Kalashnikova OV, Chasnyk VG, Aleksandrovich YS, Kostik MM. Determination of Risk Factors for Severe Life-Threatening Course of Multisystem Inflammatory Syndrome Associated with COVID-19 in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1366. [PMID: 37628366 PMCID: PMC10453228 DOI: 10.3390/children10081366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a life-threatening condition that often requires intensive care unit (ICU) admission. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. The study included 166 patients (99 boys, 67 girls) aged 4 months-17 years (median 8.2 years). The criterion of severity was the fact of ICU admission. To conduct a comparative analysis, MIS-C patients were divided into two groups: patients hospitalized in the ICU (n = 84, 50.6%) and those who did not need ICU admission (n = 82, 49.4%). Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, and neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin, and D-dimer levels. Additionally, the presence of macrophage activation syndrome was higher in patients admitted to the ICU. Conclusion: Nineteen predictors of severe course of MIS-C were found, out of which hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, troponin > 10 pg/mL were mainly associated with the probability of being classified as early predictors of severe MIS-C requiring ICU admission.
Collapse
Affiliation(s)
- Ilia S. Avrusin
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Natalia N. Abramova
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Konstantin E. Belozerov
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Gleb V. Kondratiev
- Pediatric Oncology Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Liudmila V. Bregel
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Olesya S. Efremova
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Alla A. Vilnits
- Pediatric Infectious Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
- The Research Department of Intensive Care of Emergency Conditions, Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia
| | - Julia E. Konstantinova
- The Research Department of Vaccination and Adverse Event Follow Immunization, Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia
| | - Eugenia A. Isupova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Tatiana L. Kornishina
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Vera V. Masalova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Eugeniy Yu. Felker
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Olga V. Kalashnikova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Vyacheslav G. Chasnyk
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Yuriy S. Aleksandrovich
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Mikhail M. Kostik
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| |
Collapse
|
40
|
Robinson LA, Dale M, Gorelik M. Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: A Spectrum of Postinfectious Hyperinflammatory Disease. Rheum Dis Clin North Am 2023; 49:661-678. [PMID: 37331739 DOI: 10.1016/j.rdc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Kawasaki disease and multisystem inflammatory syndrome in children are hyperinflammatory conditions that share similar emerging pathophysiology hypotheses, clinical features, treatment strategies, and outcomes. Although both conditions have key differences, growing evidence suggests that both conditions might be closely related on a larger spectrum of postinfectious autoimmune responses.
Collapse
Affiliation(s)
- Lauren Ambler Robinson
- Department of Medicine, Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA; Department of Pediatric Rheumatology, 535 East 70th Street, New York, NY 10021, USA
| | - Marissa Dale
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Morgan Stanley Children's Hospital, 3959 Broadway Central 5th Floor, New York, NY 10032, USA
| | - Mark Gorelik
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Medical Center, College of Physicians and Surgeons Building, P&S 10-451, 630 West 168th Street, New York NY 10032, USA.
| |
Collapse
|
41
|
Kim J, Shimizu C, He M, Wang H, Hoffman HM, Tremoulet AH, Shyy JYJ, Burns JC. Endothelial Cell Response in Kawasaki Disease and Multisystem Inflammatory Syndrome in Children. Int J Mol Sci 2023; 24:12318. [PMID: 37569694 PMCID: PMC10418493 DOI: 10.3390/ijms241512318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Although Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) share some clinical manifestations, their cardiovascular outcomes are different, and this may be reflected at the level of the endothelial cell (EC). We performed RNA-seq on cultured ECs incubated with pre-treatment sera from KD (n = 5), MIS-C (n = 7), and healthy controls (n = 3). We conducted a weighted gene co-expression network analysis (WGCNA) using 935 transcripts differentially expressed between MIS-C and KD using relaxed filtering (unadjusted p < 0.05, >1.1-fold difference). We found seven gene modules in MIS-C, annotated as an increased TNFα/NFκB pathway, decreased EC homeostasis, anti-inflammation and immune response, translation, and glucocorticoid responsive genes and endothelial-mesenchymal transition (EndoMT). To further understand the difference in the EC response between MIS-C and KD, stringent filtering was applied to identify 41 differentially expressed genes (DEGs) between MIS-C and KD (adjusted p < 0.05, >2-fold-difference). Again, in MIS-C, NFκB pathway genes, including nine pro-survival genes, were upregulated. The expression levels were higher in the genes influencing autophagy (UBD, EBI3, and SQSTM1). Other DEGs also supported the finding by WGCNA. Compared to KD, ECs in MIS-C had increased pro-survival transcripts but reduced transcripts related to EndoMT and EC homeostasis. These differences in the EC response may influence the different cardiovascular outcomes in these two diseases.
Collapse
Affiliation(s)
- Jihoon Kim
- Department of Biomedical Informatics, University of California, San Diego, CA 92093, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT 06510, USA
| | - Chisato Shimizu
- Department of Pediatrics, University of California, San Diego, CA 92093, USA
| | - Ming He
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Hao Wang
- Department of Pediatrics, University of California, San Diego, CA 92093, USA
| | - Hal M. Hoffman
- Department of Pediatrics, University of California, San Diego, CA 92093, USA
- Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Adriana H. Tremoulet
- Department of Pediatrics, University of California, San Diego, CA 92093, USA
- Rady Children’s Hospital, San Diego, CA 92123, USA
| | - John Y.-J. Shyy
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Jane C. Burns
- Department of Pediatrics, University of California, San Diego, CA 92093, USA
- Rady Children’s Hospital, San Diego, CA 92123, USA
| |
Collapse
|
42
|
Levine DA, Uy V, Krief W, Bornstein C, Daswani D, Patel D, Kriegel M, Jamal N, Patel K, Liang T, Arroyo A, Strother C, Lim CA, Langhan ML, Hassoun A, Chamdawala H, Kaplan CP, Waseem M, Tay ET, Mortel D, Sivitz AB, Kelly C, Lee HJ, Qiu Y, Gorelik M, Platt SL, Dayan P. Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region. Pediatr Emerg Care 2023; 39:555-561. [PMID: 36811547 DOI: 10.1097/pec.0000000000002914] [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: 02/24/2023]
Abstract
OBJECTIVES Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. METHODS We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. RESULTS Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). CONCLUSIONS Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.
Collapse
Affiliation(s)
- Deborah A Levine
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Vincent Uy
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - William Krief
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Cara Bornstein
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Dina Daswani
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Darshan Patel
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Marni Kriegel
- Department of Emergency Medicine and Pediatrics, Hackensack University Medical Center/Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nazreen Jamal
- Department of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons
| | - Kavita Patel
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Tian Liang
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Alexander Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn
| | - Christopher Strother
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Czer Anthoney Lim
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa L Langhan
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT
| | - Ameer Hassoun
- Department of Emergency Medicine, NewYork-Presbyterian Queens/Weill Cornell Medicine, Flushing
| | - Haamid Chamdawala
- Department of Pediatrics, Jacobi Hospital Center/North Central Bronx Hospital, The Bronx
| | - Carl Philip Kaplan
- Departments of Pediatrics and Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook
| | - Muhammad Waseem
- Departments of Emergency Medicine and Pediatrics, Lincoln Medical Center/Weill Cornell Medicine, The Bronx
| | - Ee Tein Tay
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine/Bellevue Hospital Center
| | - David Mortel
- Departments of Emergency Medicine and Pediatrics, Harlem Hospital Center, New York
| | - Adam B Sivitz
- Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center/Children's Hospital of New Jersey, New Jersey Medical School, Rutgers University, Newark
| | - Christopher Kelly
- Department of Emergency Medicine, NewYork-Presbyterian/Brooklyn Methodist Hospital, Brooklyn
| | | | | | | | - Shari L Platt
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Peter Dayan
- Emergency Medicine, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons, New York, NY
| |
Collapse
|
43
|
Pegoraro F, Lasagni D, Trapani S, Mastrolia MV, Simonini G, Indolfi G, Resti M. Anticoagulation and Thrombotic Events in the Multisystem Inflammatory Syndrome in Children: Experience of a Single-center Cohort and Review of the Literature. J Pediatr Hematol Oncol 2023; 45:256-261. [PMID: 36657031 DOI: 10.1097/mph.0000000000002590] [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] [Received: 03/30/2022] [Accepted: 10/07/2022] [Indexed: 01/21/2023]
Abstract
The multisystem inflammatory syndrome in children (MIS-C) is a severe clinical entity affecting the coagulative system; although thromboembolic events (TEs) are not common, most patients receive anticoagulation. We retrospectively assessed patients below 18 years admitted with MIS-C at Meyer Children's Hospital (Florence, Italy). Data on baseline clinical and laboratory presentation, treatment, and outcome, including differences between patients with and without thrombotic prophylaxis, were analyzed. Thirty-two children 1 to 15 years were included. Seventeen patients (53.1%) required intensive care admission, 2 (8.7%) had obesity, 7 (30.4%) a central venous catheter, and 14 (43.8%) an impaired cardiac function. Twelve patients (37.5%) received prophylactic anticoagulation: they had more frequent cardiac involvement (91.7 vs. 50%, P =0.02) and higher ferritin levels (median 1240 vs. 501.5 ng/mL, P <0.001). No differences were found in median d -dimers between the 2 groups. Twenty-one patients (65.6%) had d -dimers >5×upper limit of normal but the indication for anticoagulation was not driven by d -dimers. No patient had hemorrhagic events and only 1 patient (3.1%) had a superficial thrombotic event (under thromboprophylaxis). Our series and the available literature data on MIS-C and thromboembolic events suggest that TEs are a rare complication of MIS-C that is frequently associated with high d -dimer values. However, also in MIS-C, the well-established risk factors of pediatric TEs (ie, older age, central venous catheter, obesity, and cancer) should guide thromboembolic risk assessment.
Collapse
Affiliation(s)
| | | | | | | | - Gabriele Simonini
- Neurofarba Department, University of Florence
- Rheumatology Unit, Meyer Children's Hospital, Florence, Italy
| | | | | |
Collapse
|
44
|
Piccinelli E, Bautista-Rodriguez C, Herberg J, Kang H, Krupickova S, Altamar IB, Moscatelli S, Sabatino J, Josen M, Paredes J, Whittaker E, Singh Y, Fraisse A, Di Salvo G. Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children. Cardiol Young 2023; 33:1177-1183. [PMID: 35919031 DOI: 10.1017/s1047951122002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking. METHODS We reviewed echocardiography findings of all multi-system inflammatory syndrome cases between 1st April and 31st July, 2020 and typical Kawasaki disease patients with coronary arteries abnormalities consecutively followed between 1st October, 2016 and June 30th, 2019. RESULTS We included 40 multi-system inflammatory syndrome children (25 males, 62.5%) and 45 Kawasaki disease patients (31 males, 68.9%) at a mean age of 6.4 years old and 8 years old, respectively. Four out of 40 multi-system inflammatory syndrome children had coronary arteries abnormalities. Left ventricle ejection fraction was normal in both groups. Global longitudinal strain was normal although Kawasaki disease group had significantly lower values (-20.0 versus -21.7%; p = 0.02). Basal segments were the most affected in Kawasaki disease patients with significant differences in the basal anterior, anterolateral, and anteroseptal strain: -18.2 versus -23.0% (p = 0.002), -16.7 versus -22.0% (p < 0.001), -16.7 versus -19.5% (p = 0.034), respectively. The basal anterolateral and anteroseptal segments in Kawasaki disease patients were the only ones with an absolute reduction of longitudinal strain (-16.7% both) consistent with the greater left main coronary involvement in this cohort. CONCLUSIONS Our findings are consistent with the transient cardiac involvement in multi-system inflammatory syndrome, as opposed to the subtle and chronic myocardial involvement in Kawasaki disease children with coronary arteries abnormalities. We speculate that the mechanism of cardiac impairment in the few multi-system inflammatory syndrome children with reduced global longitudinal strain is not related to coronary arteries abnormalities.
Collapse
Affiliation(s)
- Enrico Piccinelli
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jethro Herberg
- Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
| | - Heechan Kang
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sylvia Krupickova
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ivan B Altamar
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sara Moscatelli
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jolanda Sabatino
- Università degli Studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Manjit Josen
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
| | - Josefa Paredes
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
| | - Elisabeth Whittaker
- Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
| | - Yogen Singh
- Neonatal Intensive Care Unit, Cambridge University Hospitals, Cambridge, UK
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Giovanni Di Salvo
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Università degli Studi di Padova, Padova, Italy
| |
Collapse
|
45
|
Erdede Ö, Sari E, Külcü NU, Sezer Yamanel RG. The Role of Mean Platelet Volume in Multisystem Inflammatory Syndrome in Children With Cardiac Manifestations. Pediatr Infect Dis J 2023; 42:601-607. [PMID: 37054394 PMCID: PMC10289071 DOI: 10.1097/inf.0000000000003917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel pediatric disorder associated with coronavirus disease 2019. However, no laboratory parameters can diagnose MIS-C. This study aimed to determine the changes in mean platelet volume (MPV) and investigate its relationship with cardiac involvement in MIS-C. METHODS In this single-center retrospective study, 35 children with MIS-C, 35 healthy children and 35 febrile children were enrolled. Patients with MIS-C were further subdivided depending on the presence of cardiac involvement. For all patients, the white blood cell, absolute neutrophil, absolute lymphocyte, platelet counts, MPV and C-reactive protein levels were recorded. Ferritin, D-dimer, troponin and CK-MB levels and the day when IVIG was administered were recorded and compared between groups. RESULTS Thirteen patients with MIS-C had cardiac involvement. The mean MPV of the MIS-C group was significantly higher than those of the healthy ( P = 0.0001) and febrile ( P = 0.027) groups. Using a cutoff of >7.6 fL, the MPV had a sensitivity of 82.86% and specificity of 82.75%, and the area under the MPV receiver operating characteristics curve was 0.896 (0.799-0.956). The MPV was significantly higher in patients with cardiac involvement than in those without ( P = 0.031). Logistic regression analysis revealed that the association between the MPV and cardiac involvement was significant (odds ratio, 2.28; 95% confidence interval, 1.04-2.95; P = 0 .039). CONCLUSIONS The MPV may indicate cardiac involvement in patients with MIS-C. Large cohort studies are needed to define an accurate cutoff value for the MPV.
Collapse
Affiliation(s)
- Özlem Erdede
- From the Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdal Sari
- From the Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nihan U. Külcü
- From the Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Rabia G. Sezer Yamanel
- From the Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
46
|
Atasayan V, Akbay ÖP, Çağlayan Ş, Sözeri B, Hasbal Akkuş C, Vuran A, Öner T, Karacan M. Cardiac involvement in multisystem inflammatory syndrome in children: single-centre experience. Cardiol Young 2023; 33:1117-1123. [PMID: 35837680 DOI: 10.1017/s1047951122002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to evaluate electrocardiographic and echocardiographic findings, Holter recordings of the multisystem inflammatory syndrome in children, and to identify prognostic factors for cardiac involvement. METHODS We retrospectively reviewed demographic characteristics, medical data, laboratory findings, electrocardiogram and echocardiographic findings, 24-hour Holter recordings, need for an ICU, and extracorporeal membrane oxygenation in multisystem inflammatory syndrome in children. Acute left ventricular systolic dysfunction was defined as left ventricular ejection fraction (EF) ≤%55 on echocardiography. RESULTS Sixty-seven children were included in the study. 24-hour Holters were recorded in 61.2% of the patients and 49.2% were normal. On echocardiographic examination, 14.9% of the patients had systolic dysfunction (EF ≤ 55%). While 32.8% of patients had mild mitral regurgitation, 3% had moderate mitral regurgitation, and 6% had mild aortic regurgitation. There was no statistically significant difference in EF values between the group with arrhythmia in Holter and the group with normal Holter results (p ≥ 0.05). B-type natriuretic peptide was positively correlated with C-reactive protein, ferritin, and fibrinogen. Significant effectivity of the B-type natriuretic peptide value was observed in the differentiation of those with EF ≤ and > 55%. Extracorporeal membrane oxygenation support was needed for three (4.5%) patients. One patient who died had systemic juvenile idiopathic arthritis. CONCLUSIONS Neutrophil/lymphocyte ratio, C-reactive protein, D-dimer, ferritin, troponin, and B-type natriuretic peptide were found to be significantly higher in patients with systolic dysfunction. Also, the cut-off value of 1700 pg/ml for B-type natriuretic peptide was significantly effective. These parameters may indicate the severity of the disease but should be supported by prospective studies.
Collapse
Affiliation(s)
- Vildan Atasayan
- Department of Pediatric Cardiology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Özge P Akbay
- Department of Pediatrics, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Canan Hasbal Akkuş
- Department of Pediatrics, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Alican Vuran
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Taliha Öner
- Department of Pediatric Cardiology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Karacan
- Department of Pediatric Cardiology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
47
|
Van Hersh A, Jawad K, Feygin Y, Johnsrude C, Dasgupta S. Significance of electrocardiogram abnormalities in children presenting to the emergency department with acute COVID-19 infection. Am J Emerg Med 2023; 71:195-199. [PMID: 37423027 PMCID: PMC10299939 DOI: 10.1016/j.ajem.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/11/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVES Acute COVID-19 infection may be associated with electrocardiogram (EKG) abnormalities in pediatric patients. We have anecdotally observed EKG abnormalities in patients without MIS-C or significant cardiac disease requiring intervention or further follow-up. Our aim was to determine the incidence of abnormal EKG findings and correlate with evidence of significant cardiac pathology in pediatric patients who present to the emergency department during an acute COVID-19 infection. METHODS We conducted a retrospective chart review of 209 pediatric patients diagnosed in the emergency department with acute COVID-19 infection and had an EKG during the same encounter; patients with MIS-C were excluded. Primary objectives included determination of the incidence of EKG abnormalities in patients presenting to the emergency department (ED) with acute COVID-19 infection who did not require hospitalization. Secondary objectives included correlation of these findings with other concomitant testing of possible cardiac pathology (echocardiograms, biomarkers), and clinical outcomes. RESULTS EKG abnormalities were identified in 84 (40%) patients. Echo was performed in 28 (13.4%) patients; only 1 was abnormal, and considered an incidental finding. The most common EKG abnormality involved nonspecific ST-T wave patterns, suggestive of but not diagnostic for underlying pericardial or myocardial disease. Serum troponin and BNP values were normal in all patients tested, either with a normal or abnormal EKG. A normal EKG had a 100% sensitivity and negative predictive value in predicting a normal echocardiogram. No patients were hospitalized and there was normalization of EKG abnormalities during short-term follow up. CONCLUSIONS Despite a high incidence of abnormal EKG repolarization patterns in pediatric patients presenting with acute (non-MIS-C) COVID-19 infections, these patients generally do not have abnormal cardiac biomarkers or echocardiograms, and the risk for adverse cardiac events is low.
Collapse
Affiliation(s)
- Andrew Van Hersh
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kahir Jawad
- Norton Children Research Institute affiliated with the University of Louisville School of Medicine, Department of Pediatrics, Child, and Adolescent Health Research Design & Support (CAHRDS) Unit, Louisville, KY, USA
| | - Yana Feygin
- Norton Children Research Institute affiliated with the University of Louisville School of Medicine, Department of Pediatrics, Child, and Adolescent Health Research Design & Support (CAHRDS) Unit, Louisville, KY, USA
| | - Christopher Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA.
| |
Collapse
|
48
|
Jarovsky D, de Freitas Fongaro G, Zampol RM, de Oliveira TA, Farias CGA, da Silva DGBP, Cavalcante DTG, Nery SB, de Moraes JC, de Oliveira FI, Almeida FJ, Sáfadi MAP. Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America's hardest-hit city. IJID REGIONS 2023; 7:52-62. [PMID: 36536932 PMCID: PMC9753484 DOI: 10.1016/j.ijregi.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In 2020, Brazil became the epicentre of the coronavirus disease (COVID-19) pandemic in Latin America, resulting in an unparalleled health catastrophe. Nevertheless, comprehensive clinical reports in Brazilian children are not available. METHODS This retrospective, hospital-based, active surveillance study was performed to identify paediatric patients with COVID-19 who presented at a private academic medical centre in a large urban area between March 2020 and March 2021. Clinical and demographic information was analysed for those requiring hospitalization, those with severe illness and those with clinical syndromes. RESULTS In total, 964 symptomatic cases were evaluated; of these, 17.7% required hospitalization, and 27.5% of hospitalized cases were classified as severe/critical. Acute bronchiolitis and pneumonia were the most common causes of hospitalization among the severe cases. Twenty-seven hospitalized children fulfilled the diagnostic criteria for multi-system inflammatory syndrome (median age 29 months; 85.2% cases were non-severe). A significant co-existing condition was present in 29% of hospitalized children. The risk of hospitalization was higher in children with at least one comorbidity, children aged <2 years and obese children. Increased risk of severe disease was described among those with leukopenia, leukocytosis or any significant comorbidity. No deaths occurred among the study population. CONCLUSION Although most children with COVID-19 experienced mild disease, and no deaths occurred among the study population, a significant proportion of cases required hospitalization and developed severe illness. Obesity, young age, underlying comorbidity, leukopenia and leukocytosis were risk factors for hospitalization or severe disease.
Collapse
Affiliation(s)
- Daniel Jarovsky
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Flávia Jacqueline Almeida
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marco Aurélio Palazzi Sáfadi
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| |
Collapse
|
49
|
Jepson BM, Beaver M, Colquitt JL, Truong DT, Crandall H, McFarland C, Williams R, Ou Z, Jensen D, Minich LL, Binka E. Left atrial strain in multisystem inflammatory syndrome in children (MIS-C) and associations with systemic inflammation and cardiac injury. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.22.23290346. [PMID: 37292768 PMCID: PMC10246144 DOI: 10.1101/2023.05.22.23290346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) commonly involves cardiac injury with both systolic and diastolic dysfunction. Left atrial strain (LAS) detects subclinical diastolic dysfunction in adults but is infrequently used in children. We evaluated LAS in MIS-C and the associations with systemic inflammation and cardiac injury. Methods In this retrospective cohort study, conventional parameters and LAS (reservoir [LAS-r], conduit [LAS-cd], and contractile [LAS-ct]) obtained from admission echocardiograms of MIS-C patients were compared to healthy controls and between MIS-C patients with and without cardiac injury (BNP >500 pg/ml or troponin-I >0.04 ng/ml). Correlation and logistic regression analyses were performed to assess LAS associations with admission inflammatory and cardiac biomarkers. Reliability testing was performed. Results Median LAS components were reduced in MIS-C patients (n=118) compared to controls (n=20) (LAS-r: 31.8 vs. 43.1%, p<0.001; LAS-cd: -28.8 vs. -34.5%, p=0.006; LAS-ct: -5.2 vs. -9.3%, p<0.001) and reduced in MIS-C patients with cardiac injury (n=59) compared to no injury (n=59) (LAS-r: 29.6 vs. 35.8%, p=0.001; LAS-cd: -26.5 vs. -30.4%, p=0.036; LAS-ct: -4.6 vs. -9.3%, p=0.008). An LAS-ct peak was absent in 65 (55%) MIS-C patients but present in all controls (p<0.001). Procalcitonin had strong correlation with averaged E/e' (r=0.55, p=0.001); ESR had moderate correlation with LAS-ct (r=-0.41, p=0.007); BNP had moderate correlation with LAS-r (r=-0.39, p<0.001) and LAS-ct (r=0.31, p=0.023), and troponin-I had only weak correlations. No strain indices were independently associated with cardiac injury on regression analysis. Intra-rater reliability was good for all LAS components; and inter-rater reliability was good to excellent for LAS-r, and fair for LAS-cd and LAS-ct. Conclusions LAS analysis, particularly the absence of a LAS-ct peak, was reproducible and may be superior to conventional echocardiographic parameters for detecting diastolic dysfunction in MIS-C. No strain parameters on admission were independently associated with cardiac injury.
Collapse
|
50
|
Holby SN, Richardson TL, Laws JL, McLaren TA, Soslow JH, Baker MT, Dendy JM, Clark DE, Hughes SG. Multimodality Cardiac Imaging in COVID. Circ Res 2023; 132:1387-1404. [PMID: 37167354 PMCID: PMC10171309 DOI: 10.1161/circresaha.122.321882] [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] [Indexed: 05/13/2023]
Abstract
Infection with SARS-CoV-2, the virus that causes COVID, is associated with numerous potential secondary complications. Global efforts have been dedicated to understanding the myriad potential cardiovascular sequelae which may occur during acute infection, convalescence, or recovery. Because patients often present with nonspecific symptoms and laboratory findings, cardiac imaging has emerged as an important tool for the discrimination of pulmonary and cardiovascular complications of this disease. The clinician investigating a potential COVID-related complication must account not only for the relative utility of various cardiac imaging modalities but also for the risk of infectious exposure to staff and other patients. Extraordinary clinical and scholarly efforts have brought the international medical community closer to a consensus on the appropriate indications for diagnostic cardiac imaging during this protracted pandemic. In this review, we summarize the existing literature and reference major societal guidelines to provide an overview of the indications and utility of echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging for the diagnosis of cardiovascular complications of COVID.
Collapse
Affiliation(s)
- S Neil Holby
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Tadarro Lee Richardson
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - J Lukas Laws
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Thomas A McLaren
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| | - Jonathan H Soslow
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics (J.H.S.), Vanderbilt University Medical Center
| | - Michael T Baker
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Jeffrey M Dendy
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Daniel E Clark
- Division of Cardiology, Department of Internal Medicine, Stanford University School of Medicine (D.E.C.)
| | - Sean G Hughes
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| |
Collapse
|