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Vainstein E, Baleani S, Urrutia L, Affranchino N, Ackerman J, Cazalas M, Goldsman A, Sardella A, Tolin AL, Goldaracena P, Fabi M, Cosentino M, Magliola R, Roggiero G, Manso P, Triguy J, Ballester C, Cervetto V, Vaccarello M, De Carli DN, De Carli ME, Ciotti AL, Sicurello MI, Rios Leiva C, Villalba C, Hortas M, Peña S, González G, Zold CL, Murer MG, Vázquez H, Morós C, Di Santo M, Villa A, Lazota P, Foti M, Napoli N, Katsikas MM, Tonello L, Peña J, Etcheverry M, Iglesias D, Alcalde AL, Bruera MJ, Bruzzo V, Giordano P, Acero FP, Pelandi GN, Pastaro D, Bleiz J, Rodríguez MF, Laghezza L, Molina MB, Patynok N, Chatelain, Aguilar MJ, Gamboa J, Cervan M, Ruggeri A, Marinelli I, Checcacci E, Meregalli C, Damksy Barbosa J, Fernie L, Fernández MJ, Saenz Tejeira MM, Cereigido C, Nunell A, Villar D, Mansilla AD, Darduin MD. Multicentre observational study on multisystem inflammatory syndrome related to COVID-19 in Argentina. Pediatr Int 2023; 65:e15431. [PMID: 36464947 PMCID: PMC9878215 DOI: 10.1111/ped.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. METHODS This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. RESULTS Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. CONCLUSION Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.
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Affiliation(s)
- Eduardo Vainstein
- Clínica Pediátrica, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Silvia Baleani
- Clínica Pediátrica, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Luis Urrutia
- Clínica Pediátrica, Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - Nicolás Affranchino
- Clínica Pediátrica, Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - Judith Ackerman
- Unidad de Cardiología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Mariana Cazalas
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez y Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Alejandro Goldsman
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez y Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Angela Sardella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ana Laura Tolin
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Pablo Goldaracena
- Clínica Médica, Hospital Sor María Ludovica de La Plata, Provincia de Buenos Aires, Argentina
| | - Mariana Fabi
- Servicio de Reumatología, Hospital Sor María Ludovica de La Plata, Provincia de Buenos Aires, Argentina
| | | | - Ricardo Magliola
- Clínica Pediátrica, Unidad Terapia Intensiva, Hospital Británico, Buenos Aires, Argentina
| | - Gustavo Roggiero
- Servicio de Cardiología, Hospital El Cruce Néstor Carlos Kirchner y Clínica del Niño de Quilmes, Provincia de Buenos Aires, Argentina
| | - Paula Manso
- Servicio de Cardiología, Hospital El Cruce Néstor Carlos Kirchner, Provincia de Buenos Aires, Argentina
| | - Jésica Triguy
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Celeste Ballester
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Vanesa Cervetto
- Reumatología, Hospital General de Niños Pedro de Elizalde y Hospital Británico, Buenos Aires, Argentina
| | - María Vaccarello
- Clínica Pediátrica, Sanatorio la Trinidad, Quilmes, Provincia de Buenos Aires, Argentina
| | | | - Maria Estela De Carli
- Clínica Pediátrica, Clínica del Niño de Quilmes, Provincia de Buenos Aires, Argentina
| | - Ana Laura Ciotti
- Servicio de Cardiología, Hospital A. Posadas, Provincia de Buenos Aires, Argentina
| | - María Irene Sicurello
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Cecilia Rios Leiva
- Servicio de Cardiología, Hospital Eva Perón de San Martín, Provincia de Buenos Aires, Argentina
| | - Claudia Villalba
- Servicio de Cardiología, Hospital Británico y Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - María Hortas
- Servicio de Reumatología, Sanatorio la Trinidad, Quilmes, Provincia de Buenos Aires, Argentina
| | - Sonia Peña
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Gabriela González
- Servicio de Cardiología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Camila Lidia Zold
- Universidad de Buenos Aires, CONICET, Instituto de Fisiología y Biofísica (IFIBIO) Bernardo Houssay, Buenos Aires, Argentina
| | - Mario Gustavo Murer
- Universidad de Buenos Aires, CONICET, Instituto de Fisiología y Biofísica (IFIBIO) Bernardo Houssay, Buenos Aires, Argentina
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