Clinics (Aug 2020)

Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

  • Maria Fernanda Badue Pereira,
  • Nadia Litvinov,
  • Sylvia Costa Lima Farhat,
  • Adriana Pasmanik Eisencraft,
  • Maria Augusta Bento Cicaroni Gibelli,
  • Werther Brunow de Carvalho,
  • Vinicius Rodrigues Fernandes,
  • Thais de Toledo Fink,
  • Juliana Valéria de Souza Framil,
  • Karine Vusberg Galleti,
  • Alice Lima Fante,
  • Maria Fernanda Mota Fonseca,
  • Andreia Watanabe,
  • Camila Sanson Yoshino de Paula,
  • Giovanna Gavros Palandri,
  • Gabriela Nunes Leal,
  • Maria de Fatima Rodrigues Diniz,
  • João Renato Rebello Pinho,
  • Clovis Artur Silva,
  • Heloisa Helena de Sousa Marques,
  • Alfio Rossi Junior,
  • Artur Figueiredo Delgado,
  • Anarella Penha Meirelles de Andrade,
  • Claudio Schvartsman,
  • Ester Cerdeira Sabino,
  • Mussya Cisotto Rocha,
  • Kelly Aparecida Kanunfre,
  • Thelma Suely Okay,
  • Magda Maria Sales Carneiro-Sampaio,
  • Patricia Palmeira Daenekas Jorge

DOI
https://doi.org/10.6061/clinics/2020/e2209
Journal volume & issue
Vol. 75

Abstract

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OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.

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