Multicenter Validation of a Machine Learning Algorithm for Diagnosing Pediatric Patients with Multisystem Inflammatory Syndrome and Kawasaki Disease

Lam, Jonathan Y.; Roberts, Samantha C.; Shimizu, Chisato; Bainto, Emelia; Sivilay, Nipha; Tremoulet, Adriana H.; Gardiner, Michael; Kanegaye, John T.; Hogan, Alexander H.; Salazar, Juan C.; Mohandas, Sindhu; Szmuszkovicz, Jacqueline R.; Mahanta, Simran; Dionne, Audrey; Ansusinha, Emily; DeBiasi, Roberta L.; Hao, Shiying; Ling, Xuefeng B.; Cohen, Harvey J.; Nemati, Shamim; Burns, Jane C.

doi:10.1101/2022.02.07.21268280

Cited by 4 publications

(7 citation statements)

References 16 publications

(24 reference statements)

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“…O diagnóstico é baseado na evidência de inflamação sistêmica (por exemplo, febre) em associação com sinais de inflamação mucocutânea. A conjuntivite bilateral não exsudativa característica, eritema dos lábios e da mucosa oral, erupção cutânea, alterações nas extremidades e linfadenopatia cervical geralmente se desenvolvem após um breve pródromo inespecífico de sintomas respiratórios ou gastrointestinais (Emeksiz et al, 2021;Lam et al, 2022).…”

Section: Resultsunclassified

“…Atualmente, sabemos que PIMS-TS ou SIM-P podem apresentar sintomas clínicos variáveis, incluindo febre, diarreia e erupção cutânea, dificultando a diferenciação de outras doenças e síndromes febris. Como é importante reconhecer e tratar prontamente essas crianças que podem se deteriorar rapidamente e exigir monitoramento de terapia intensiva (Falqueto et al, 2022;Lam et al, 2022).…”

Section: Resultsunclassified

“…Com a análise dos dados observou-se que os pacientes com SIM-P foram, em sua maioria, inicialmente manejados para com a hipótese diagnóstica para DK, dessa forma o ponto incial de conduta incluía investigações laboratoriais hemograma, perfil bioquímico (incluindo ferritina, troponina, peptídeo natriurético cerebral), marcadores inflamatórios (PCR, VHS e IL-6), perfil de coagulação (incluindo d-dímero e fibrinogênio), enzimas hepáticas (ALT e AST), albumina, CK-MB, sangue para cultura, amostragem nasofaríngea para patógenos virais e soro guardado para teste sorológico (Emeksiz et al, 2021;Lam et al, 2022).…”

Section: Resultsunclassified

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Principais manifestações clínicas da Síndrome inflamatória multissistêmica pediátrica (SIM-P) associada a COVID-19

Cardoso

Araujo²,

Garcês³

et al. 2022

RSD

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No final de 2019, em Wuhan, na China, foi identificado o surgimento de um novo vírus, denominado coronavírus de síndrome respiratória aguda grave 2 (SARS-CoV-2, do inglês Severe acute respiratory syndrome-associated coronavirus 2), causador da COVID-19, uma doença infectocontagiosa. As caraterísticas clínicas dos pacientes com essa doença são bastante variáveis, podendo apresentar-se de forma leve, grave e até mesmo fatal. Ainda que não haja grandes incidências na pediatria, uma nova apresentação, responsável por acometer crianças e adolescentes e que pode ter uma associação causal ao SARS-CoV-2, foi denominada como síndrome inflamatória multissistêmica pediátrica (SIM-P). Tal condição remete a um acometimento grave de crianças e que necessitam de intervenção hospitalar devido a quadro inflamatório intenso, associado à febre persistente, que pode levar à choque e falência de múltiplos órgãos. Tem-se como objetivo identificar a associação entre SIM-P e COVID-19 e suas principais manifestações clinicas, através de uma revisão sistemática de literatura em diferentes regiões brasileiras, de forma a colaborar na abordagem médica e no conhecimento científico a respeito da SIM-P, auxiliando na otimização do seu diagnóstico e tratamento, uma vez que, os dados sobre a temática ainda são escassos. Este trabalho consiste em uma revisão sistemática de literatura, de caráter quantitativo e descritivo, na qual foram utilizados como bases de dados a Scientific Electronic Library Online (SciELO), U.S. National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS), usando palavras-chave presentes nos Descritores em Ciências da Saúde (DeCS).

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Section: Resultsunclassified

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Principais manifestações clínicas da Síndrome inflamatória multissistêmica pediátrica (SIM-P) associada a COVID-19

Cardoso

Araujo²,

Garcês³

et al. 2022

RSD

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“…Patients are at higher risk of developing myocarditis with acute heart failure and may require longer time in the hospital and admittance to an intensive care unit. Recently, Lam Y et al [39] proposed an algorithm (KIDMATCH) for screening patients for MIS-C, KD, or other febrile illness. Many treatment protocols recommend using IVIG and aspirin with/without GCS as first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of Kawasaki disease in Polish children: A retrospective study

Smorczewska-Kiljan

Marszał

Friedman-Gruszczyńska

et al. 2022

Kardiol Pol

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Background: Kawasaki disease (KD), an acute, generalized vasculitis, is associated with an increased risk of coronary heart disease and is the most common cause of acquired heart disease in childhood. The incidence of KD is increasing worldwide. Aims:Our study aims to analyze KD's clinical course in children and to evaluate risk factors for persistent changes in coronary vessels after 6-8 weeks of treatment. Methods:The retrospective analysis included patients with KD hospitalized in a single tertiary care hospital. The diagnosis, as well as treatment, were based on the current worldwide treatment standards. The clinical course, selected laboratory parameters, the treatment effect, and following cardiac complications were analyzed in different age groups. Results:In the years 2006-2019, 140 patients aged from two months to 16 years: 52 girls and 88 boys, were diagnosed with KD. Coronary artery aneurysms (CAA) at weeks 6-8 of disease were found in 16% of patients. Boys and infants were more likely to develop aneurysms at weeks 6-8 of the disease (P = 0.045; P = 0.03; respectively). The CAA frequency was related to the atypical course (P = 0.02), late diagnosis (P = 0.04), presence of changes in the coronary arteries at the time of diag nosis (P <0.001), immunoglobulin resistance (P = 0.002), a lower hemoglobin concentraction (P <0.001), and a higher platelet count (P = 0.02). There were 28% of patients resistant to first-line time treatment. In this group, we found CAA in 31% of children. Conclusions:We found that late diagnosis, low hemoglobin level, high platelet count, CAA presence at diagnosis, atypical course of KD, and resistance to intravenous immunoglobulins are predictors of CAA after 6-8 weeks in KD patients.

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“…Additional literature dedicated toward describing and distinguishing MIS‐C is expanding rapidly in both volume and complexity ( 1 , 16 , 17 , 18 , 19 , 20 ). Machine learning methods have been used by Geva et al ( 18 ) to group patients hospitalized with COVID‐19‐related illness into phenotypic clusters with varying likelihood of MIS‐C and by Lam et al ( 20 ) to assign risk scores for MIS‐C and KD.…”

Section: Discussionmentioning

confidence: 99%

A Diagnostic Prediction Model to Distinguish Multisystem Inflammatory Syndrome in Children

Clark

Rankin

Peetluk

et al. 2022

ACR Open Rheumatology

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Objective Features of multisystem inflammatory syndrome in children (MIS‐C) overlap with other syndromes, making the diagnosis difficult for clinicians. We aimed to compare clinical differences between patients with and without clinical MIS‐C diagnosis and develop a diagnostic prediction model to assist clinicians in identification of patients with MIS‐C within the first 24 hours of hospital presentation. Methods A cohort of 127 patients (<21 years) were admitted to an academic children's hospital and evaluated for MIS‐C. The primary outcome measure was MIS‐C diagnosis at Vanderbilt University Medical Center. Clinical, laboratory, and cardiac features were extracted from the medical record, compared among groups, and selected a priori to identify candidate predictors. Final predictors were identified through a logistic regression model with bootstrapped backward selection in which only variables selected in more than 80% of 500 bootstraps were included in the final model. Results Of 127 children admitted to our hospital with concern for MIS‐C, 45 were clinically diagnosed with MIS‐C and 82 were diagnosed with alternative diagnoses. We found a model with four variables—the presence of hypotension and/or fluid resuscitation, abdominal pain, new rash, and the value of serum sodium—showed excellent discrimination (concordance index 0.91; 95% confidence interval: 0.85‐0.96) and good calibration in identifying patients with MIS‐C. Conclusion A diagnostic prediction model with early clinical and laboratory features shows excellent discrimination and may assist clinicians in distinguishing patients with MIS‐C. This model will require external and prospective validation prior to widespread use.

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Multicenter Validation of a Machine Learning Algorithm for Diagnosing Pediatric Patients with Multisystem Inflammatory Syndrome and Kawasaki Disease

Cited by 4 publications

References 16 publications

Principais manifestações clínicas da Síndrome inflamatória multissistêmica pediátrica (SIM-P) associada a COVID-19

Principais manifestações clínicas da Síndrome inflamatória multissistêmica pediátrica (SIM-P) associada a COVID-19

Clinical characteristics of Kawasaki disease in Polish children: A retrospective study

A Diagnostic Prediction Model to Distinguish Multisystem Inflammatory Syndrome in Children

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