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Sık G, Inamlık A, Akçay N, Kesici S, Aygun F, Kendırlı T, Atay G, Sandal O, Varol F, Ozkaya PY, Duyu M, Bırbılen AZ, Ozcan S, Arslan G, Kangın M, Bayraktar S, Altug U, Anıl AB, Havan M, Yetımakman AF, Dalkıran T, Zengın N, Oto A, Kıhtır HS, Gırgın Fİ, Telhan L, Yıldızdas D, Yener N, Yukselmıs U, Alakaya M, Kılınc MA, Celegen M, Dursun A, Battal F, Sarı F, Ozkale M, Topal S, Kocaoglu C, Yazar A, Alacakır N, Odek C, Yaman A, Cıtak A. Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study. Pediatr Res 2023:10.1038/s41390-023-02518-0. [PMID: 36813951 PMCID: PMC9946280 DOI: 10.1038/s41390-023-02518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
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Affiliation(s)
- Guntulu Sık
- Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
| | - Aysegul Inamlık
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nihal Akçay
- grid.414177.00000 0004 0419 1043Department of Pediatric Intensive Care, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Fatih Aygun
- grid.506076.20000 0004 1797 5496Department of Pediatric Intensive Care, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Tanıl Kendırlı
- grid.7256.60000000109409118Department of Pediatric Intensive Care, Ankara University, Ankara, Turkey
| | - Gurkan Atay
- grid.417018.b0000 0004 0419 1887Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Sandal
- Department of Pediatric Intensive Care, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatih Varol
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Sancaktepe Şehit Prof. MD İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı Ozkaya
- grid.8302.90000 0001 1092 2592Department of Pediatric Intensive Care, Ege University, Izmir, Turkey
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Goztepe Prof. MD Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ahmet Ziya Bırbılen
- Department of Pediatric Intensive Care, Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep, Turkey
| | - Serhan Ozcan
- grid.449874.20000 0004 0454 9762Department of Pediatric Intensive Care, Ankara Yıldırım Beyazıt University, Ankara Children’s Hospital, Ankara, Turkey
| | - Gazi Arslan
- grid.21200.310000 0001 2183 9022Department of Pediatric Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey
| | - Murat Kangın
- Department of Pediatric Intensive Care, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Suleyman Bayraktar
- grid.413752.60000 0004 0419 1465Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Umit Altug
- Department of Pediatric Intensive Care, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Ayşe Berna Anıl
- Department of Pediatric Intensive Care, Tepecik Training and Research Hospital, Izmır Katip Çelebi University, Izmir, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Hospital, Mersin, Turkey
| | - Ayse Filiz Yetımakman
- grid.411105.00000 0001 0691 9040Department of Pediatric Intensive Care, Kocaeli University, Kocaeli, Turkey
| | - Tahir Dalkıran
- Department of Pediatric Intensive Care, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Neslihan Zengın
- grid.411688.20000 0004 0595 6052Department of Pediatric Intensive Care, Manisa Celal Bayar Unıversity, Manisa, Turkey
| | - Arzu Oto
- Department of Pediatric Intensive Care, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hasan Serdar Kıhtır
- grid.413819.60000 0004 0471 9397Department of Pediatric Intensive Care, Antalya Training and Research Hospital, Antalya, Turkey
| | - Feyza İnceköy Gırgın
- grid.16477.330000 0001 0668 8422Department of Pediatric Intensive Care, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Leyla Telhan
- grid.411781.a0000 0004 0471 9346Department of Pediatric Intensive Care, Medipol University, Istanbul, Turkey
| | - Dincer Yıldızdas
- grid.98622.370000 0001 2271 3229Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Nazik Yener
- grid.411049.90000 0004 0574 2310Department of Pediatric Intensive Care, Samsun 19 Mayıs University, Samsun, Turkey
| | - Ufuk Yukselmıs
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Alakaya
- grid.411691.a0000 0001 0694 8546Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Celegen
- Department of Pediatric Intensive Care, Afyonkarahisar Tarining and Research Hospital, Afyon, Turkey
| | - Adem Dursun
- grid.513116.1Department of Pediatric Intensive Care, Kayseri City Hospital, Kayseri, Turkey
| | - Fatih Battal
- grid.412364.60000 0001 0680 7807Department of Pediatric Intensive Care, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ferhat Sarı
- grid.14352.310000 0001 0680 7823Department of Pediatric Intensive Care, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Murat Ozkale
- grid.411548.d0000 0001 1457 1144Department of Pediatric Intensive Care, Dr Turgut NOYAN Hospital, Baskent University, Adana, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Bölge Training and Research Hospital, Erzurum, Turkey
| | - Celebi Kocaoglu
- Department of Pediatric Intensive Care, Konya City Hospital, Konya, Turkey
| | - Abdullah Yazar
- grid.411124.30000 0004 1769 6008Department of Pediatric Intensive Care, Necmettin Erbakan University, Konya, Turkey
| | - Nuri Alacakır
- grid.411693.80000 0001 2342 6459Department of Pediatric Intensive Care, Trakya University, Edirne, Turkey
| | - Caglar Odek
- grid.34538.390000 0001 2182 4517Department of Pediatric Intensive Care, Bursa Uludağ University, Bursa, Turkey
| | - Ayhan Yaman
- grid.508740.e0000 0004 5936 1556Department of Pediatric Intensive Care, Istınye University Liv Hospital, Istanbul, Turkey
| | - Agop Cıtak
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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