Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Ludwikowska, Kamila; Moksud, Nafeesa; Tracewski, Paweł; Sokolski, Mateusz; Szenborn, Leszek

doi:10.3390/biomedicines11051251

Cited by 9 publications

(5 citation statements)

References 58 publications

(103 reference statements)

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Section: Discussionsupporting

confidence: 90%

“…Similar to these results are those presented by Ludwikowska et al (2023), who estimated that 91.5% of MIS-C patients present with cardiac involvement, including valvular insufficiency (48.2%), contractility abnormalities (41%), and a decreased left ventricular ejection fraction <55% (35.6%). The authors, however, suggested that the incidence of ventricular dysfunction might be underestimated [56]. The authors also demonstrated some associations between echo abnormalities, neurological symptoms (headache, agitation, lethargy), and breathing difficulties, usually combined with high levels of troponin and procalcitonin.…”

Section: Discussionsupporting

confidence: 90%

“…The authors also demonstrated some associations between echo abnormalities, neurological symptoms (headache, agitation, lethargy), and breathing difficulties, usually combined with high levels of troponin and procalcitonin. Valvular insufficiency was found in 48% of the children (mitral insufficiency in 43% of the children), and tricuspid insufficiency was found in 19% of the children [56]. In contrast, we found that 5% and 9% of our subjects were affected, respectively, which is a much lower rate than that reported by Ludwikowska.…”

Section: Discussioncontrasting

confidence: 75%

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Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Mileva,

Vasilev,

Ganev

et al. 2023

Medicina

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Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 75%

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Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Mileva,

Vasilev,

Ganev

et al. 2023

Medicina

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“…The importance of the inflammatory repsonce in the pathogenesis of cardiac commplications in the course of COVID-19 is well established in the have multisystem inflammatory syndrome in children, which is late immune-mediated complication occurring after SARS-CoV-2 infection 40 , 41 . Thus, beneficial impact of AP on hospital course and mortality in COVID-19 can be explained by anti-inflammatory effects of AP agents 15 – 18 , 42 .…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

Sokolski,

Reszka,

Adamik

et al. 2024

Sci Rep

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One of the major pathomechanisms of COVID-19 is the interplay of hyperinflammation and disruptions in coagulation processes, involving thrombocytes. Antiplatelet therapy (AP) by anti-inflammatory effect and inhibition of platelet aggregation may affect these pathways. The aim of this study was to investigate if AP has an impact on the in-hospital course and medium-term outcomes in hospitalized COVID-19 patients. The study population (2170 COVID-19 patients: mean ± SD age 60 ± 19 years old, 50% male) was divided into a group of 274 patients receiving any AP prior to COVID-19 infection (AP group), and after propensity score matching, a group of 274 patients without previous AP (non-AP group). Patients from the AP group were less frequently hospitalized in the intensive care unit: 9% vs. 15%, 0.55 (0.33–0.94), developed less often shock: 9% vs. 15%, 0.56 (0.33–0.96), and required less aggressive forms of therapy. The AP group had more coronary revascularizations: 5% vs. 1%, 3.48 (2.19–5.55) and strokes/TIA: 5% vs. 1%, 3.63 (1.18–11.2). The bleeding rate was comparable: 7% vs. 7%, 1.06 (0.54–2.06). The patients from the AP group had lower 3-month mortality: 31% vs. 39%, 0.69 (0.51–0.93) and didn’t differ significantly in 6-month mortality: 34% vs. 41%, 0.79 (0.60–1.04). When analyzing the subgroup with a history of myocardial infarction and/or coronary revascularization and/or previous stroke/transient ischemic attack and/or peripheral artery disease, AP had a beneficial effect on both 3-month: 37% vs. 56%, 0.58 (0.40–0.86) and 6-month mortality: 42% vs. 57%, 0.63 (0.44–0.92). Moreover, the favourable effect was highly noticeable in this subgroup where acetylsalicylic acid was continued during hospitalization with reduction of in-hospital: 19% vs. 43%, 0.31 (0.15–0.67), 3-month: 30% vs. 54%, 044 (0.26–0.75) and 6-month mortality: 33% vs. 54%, 0.49 (0.29–0.82) when confronted with the subgroup who had acetylsalicylic acid suspension during hospitalization. The AP may have a beneficial impact on hospital course and mortality in COVID-19 and shouldn’t be discontinued, especially in high-risk patients.

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“…Recent reviews on the manifestations of cardiac involvement in patients with MIS‐C revealed a high rate of coronary artery dilatation or aneurysms ranging from 14% to 48% 40–42 . While no specific risk factors or demographic features for early identification of those at risk were previously reported, a recent report by Ludwikowska et al 43 . stated that younger children are more likely to develop coronary artery abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study

Tseng,

Lin,

Huang

et al. 2023

Int J of Rheum Dis

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BackgroundMultisystem inflammatory syndrome in children (MIS‐C) is a rare and serious systemic inflammatory disorder that occurs following a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. This study aims to investigate the clinical manifestations, risk factors associated with pediatric intensive care unit (PICU) admission, and outcome among children with MIS‐C in Taiwan.MethodsA retrospective analysis was conducted among pediatric patients diagnosed with MIS‐C between June 2022 and February 2023 at Chang Gung Memorial Hospital, Linkou, Taiwan. Data on demographics, clinical features, laboratory findings, treatment modalities, and outcomes were collected and analyzed.ResultsTwenty‐eight MIS‐C patients, including 9 boys and 19 girls, with an average age of 5.3 ± 3.8 years old, were enrolled. Most of the cases (78.6%) were diagnosed following the first pandemic wave of COVID‐19 in Taiwan. The leading clinical manifestations observed were fever (100%), skin rash (64.3%), tachycardia (46.4%), and vomiting (46.4%). Nine patients (32.1%) were admitted to the PICU due to hypotension or neurological manifestations. Higher levels of band‐form white blood cells, procalcitonin, ferritin, d‐dimer, prothrombin time, NT‐proBNP, and lower platelet levels on arrival were associated with PICU admission (p = 3.9 × 10−2,9 × 10−3, 4 × 10−3,1 × 10−3, 5 × 10−3, 4.1 × 10−2, and 3.4 × 10−2, respectively). Arrhythmia in one case (3.5%) and coronary artery abnormalities, including dilatation in two cases (7.1%) and small aneurysms in one case (3.5%) were identified. Regardless of ICU admission, no patients experienced systolic dysfunction or mortality following treatment.ConclusionMIS‐C cases in Taiwan have a favorable outcome. Although one‐third of the patients required PICU admission, none of the MIS‐C cases resulted in severe cardiovascular morbidity or mortality. This study provides valuable insights into the clinical manifestations and outcomes associated with PICU admission in children with MIS‐C in Taiwan.

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Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Cited by 9 publications

References 58 publications

Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study

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