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

2020; Elsevier BV; Volume: 75; Linguagem: Inglês

10.6061/clinics/2020/e2209

1980-5322

Maria Fernanda Bádue 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, Andréia Watanabe, Camila Sanson Yoshino de Paula, Giovanna Gavros Palandri, Gabriela Nunes Leal, Maria de Fátima Rodrigues Diniz, João Renato Rebello Pinho, Clóvis A. Silva, Heloísa Helena de Sousa Marques, Alfio Rossi, Artur Figueiredo Delgado, Anarella Penha Meirelles de Andrade, Cláudio Schvartsman, Éster Cerdeira Sabino, Mussya Cisotto Rocha, Kelly Aparecida Kanunfre, Thelma Suely Okay, Magda Carneiro‐Sampaio, Patricia Palmeira Daenekas Jorge,

COVID-19 Impact on Reproduction

To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). This cross-sectional study included 471 samples collected from 371 patients (age 50 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]. 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.