1
|
Yamazaki-Nakashimada MA, Márquez-González H, Miranda-Novales G, Neme Díaz GA, Prado Duran SA, Luévanos Velázquez A, Castilla-Peon MF, González-García N, Sánchez Duran MA, Márquez Aguirre MP, Villasis-Keever MA, Aragón Nogales R, Núñez-Enríquez JC, Martinez Bustamante ME, Aguilar Argüello C, Ramírez de los Santos J, Pérez Barrera A, Palacios Cantú LA, Membrila Mondragón J, Vizcarra Alvarado P, Jiménez Juárez RN, Olivar López V, Velasco-Segura R, López Chávez A. Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico. Front Pediatr 2023; 11:1167871. [PMID: 37274824 PMCID: PMC10233130 DOI: 10.3389/fped.2023.1167871] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. Methods This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. Results The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4-2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8-31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2-14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05-13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9-463) were risk factors for death. Discussion Mortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maria F. Castilla-Peon
- Hospital Psiquiatrico Infantil Juan N Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Nadia González-García
- Department of Rheumatology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | | | | | | | - Ranferi Aragón Nogales
- XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | - Víctor Olivar López
- Department of Rheumatology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Roberto Velasco-Segura
- Instituto de Ciencias Aplicada y Tecnología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Adrián López Chávez
- Department of Rheumatology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| |
Collapse
|