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

Pereira, Maria Fernanda Bádue; Litvinov, Nadia; Farhat, Sylvia Costa Lima; Eisencraft, Adriana Pasmanik; Gibelli, Maria Augusta Bento Cicaroni; Carvalho, Werther Brunow de; Fernandes, Vinicius Rodrigues; Fink, Thais de Toledo; Framil, Juliana Valéria de Souza; Galleti, Karine Vusberg; Fante, Alice Lima; Fonseca, Maria Fernanda Mota; Watanabe, Andréia; Paula, Camila Sanson Yoshino de; Palandri, Giovanna Gavros; Leal, Gabriela Nunes; Diniz, Maria de Fátima Rodrigues; Pinho, João Renato Rebello; Silva, Clóvis A.; Marques, Heloísa Helena de Sousa; Rossi, Alfioâ; Delgado, Artur Figueiredo; Andrade, Anarella Penha Meirelles de; Schvartsman, Cláudio; Sabino, Éster Cerdeira; Rocha, Mussya Cisotto; Kanunfre, Kelly Aparecida; Okay, Thelma Suely; Carneiro‐Sampaio, Magda; Jorge, Patricia Palmeira Daenekas

doi:10.6061/clinics/2020/e2209

Cited by 74 publications

(101 citation statements)

References 30 publications

(44 reference statements)

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“…The initial literature search yielded 1397 articles from all the databases. A nal total of 20 studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] were included after screening based on the inclusion criteria ( Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Meta-analysis of in ammatory markers ( Table 2, eFigure 2-7) MIS-C vs. severe/non-severe COVID-19 [13][14][15][16][17][18][19][20] We found no statistically signi cant difference in white blood cell count (WBC) or leukocytes (× A moderate degree of heterogeneity was reported in four comparisons: ALC in MIS-C vs. COVID-19(p < 0.05, I 2 = 71.4%), ALC in MIS-C vs. non-severe COVID-19(p = 0.043, I 2 = 59.4%), ANC in MIS-C vs. severe COVID-19(p = 0.063, I 2 = 71.0%) and CRP in MIS-C vs. COVID-19(p < 0.05, I 2 = 69.5%). Rest of the comparisons showed no signi cant difference in statistical heterogeneity.…”

Section: Supplement)mentioning

confidence: 99%

“…Except for ve studies 20-22, 29,31 , rest of the studies had fewer than 100 enrolled participants. Eight studies [13][14][15][16][17][18][19][20] compared MIS-C and COVID-19 along with subgroup analysis of MIS-C and severe/non-severe COVID-19; ve studies 13,14,21,22,24 compared MIS-C and KD, ve studies 21-23, 25,26 compared severe and non-severe MIS-C, three studies 21,23,27 compared MIS-C with and without coronary artery abnormality, four studies 22,30−32 compared KD during and before SARS-CoV-2 epidemic, while two studies 28,29 compared MIS-C across different age periods (0-4/0-5 years representing the younger age of infants or preschoolers, 5-12/6-12 years representing the medium age of school-age and 13-20 years representing older age of puberty or post-puberty). All study features and characteristics are presented in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Meta-analysis of in ammatory markers (Table 2, eFigure 2-7) MIS-C vs. severe/non-severe COVID-19 [13][14][15][16][17][18][19][20] We found no statistically signi cant difference in white blood cell count (WBC) or leukocytes (× MIS-C vs. KD 13,14,21,22,24 Compared to patients with KD, MIS-C patients had lower levels for ALC(× 10 9 /L) [WMD (95%CI): -2.07 (-2.34, -1.79), p < 0.001] and PLT(× 10 9 /L) [WMD (95%CI): -219.46 (-237.41, -201.51), p < 0.001], while higher levels were noted for CRP [SMD (95%CI): 0.57 (0.25, 0.90), p < 0.01] and ferritin(ng/mL) [WMD (95%CI): 647.00 (464.91, 829.09), p < 0.001] and the same level was noted for ESR(mm/hr) [WMD (95%CI): -21.33 (-61.91, 19.26), p = 0.303]. Only one comparison of CRP level showed a moderate degree of heterogeneity (p = 0.069, I 2 = 51.2%).…”

Section: Study Characteristicsmentioning

confidence: 99%

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The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

Zhao¹,

Yin

Patel

et al. 2021

Preprint

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As per the indicated need in literature, we conducted a systematic review and meta-analysis to characterize inflammatory markers of MIS-C patients with COVID-19, Kawasaki disease (KD), and coronary artery abnormalities. We searched nine databases for studies on inflammatory markers of MIS-C. After quality check, data were pooled using a fixed- or random-effects model. Inflammatory markers included white blood cell count (WBC) or leukocytes, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, lactate dehydrogenase (LDH), fibrinogen and erythrocyte sedimentation rate (ESR) for comparisons by severity and age. Twenty studies with 2,990 participants yielded 684 MIS-C patients. Compared to non-severe COVID-19 patients, MIS-C patients had lower ALC and higher ANC, CRP and D-dimer levels. Compared to severe COVID-19 patients, MIS-C patients had lower LDH and PLT counts and higher ESR levels. Compared to KD patients, MIS-C patients had lower ALC and PLT, and higher CRP and ferritin levels. Severe MIS-C patients had higher levels of WBC, CRP, D-dimer and ferritin. For MIS-C, younger children had lower CRP and ferritin levels than medium-aged/older children. Measurement of inflammatory markers might assist clinicians in accurate evaluation and diagnosis of MIS-C and the associated disorders.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Supplement)mentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

“…Meta-analysis of in ammatory markers (Table 2, eFigure 2-7) MIS-C vs. severe/non-severe COVID-19 [13][14][15][16][17][18][19][20] We found no statistically signi cant difference in white blood cell count (WBC) or leukocytes (× MIS-C vs. KD 13,14,21,22,24 Compared to patients with KD, MIS-C patients had lower levels for ALC(× 10 9 /L) [WMD (95%CI): -2.07 (-2.34, -1.79), p < 0.001] and PLT(× 10 9 /L) [WMD (95%CI): -219.46 (-237.41, -201.51), p < 0.001], while higher levels were noted for CRP [SMD (95%CI): 0.57 (0.25, 0.90), p < 0.01] and ferritin(ng/mL) [WMD (95%CI): 647.00 (464.91, 829.09), p < 0.001] and the same level was noted for ESR(mm/hr) [WMD (95%CI): -21.33 (-61.91, 19.26), p = 0.303]. Only one comparison of CRP level showed a moderate degree of heterogeneity (p = 0.069, I 2 = 51.2%).…”

Section: Study Characteristicsmentioning

confidence: 99%

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The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

Zhao¹,

Yin

Patel

et al. 2021

Preprint

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“…These pediatric patients often show severe and complex conditions with an unpredictable course that require several medications and the input from multiple pediatric specialists. Despite the concern that these patients may have severe infections related to other viral agents, such as adenovirus, rhinovirus, influenza, and respiratory syncytial virus, knowledge of the overall impact of COVID-19 in this population remains incomplete ( 7 - 9 ).…”

mentioning

confidence: 99%

Assistance and health care provided to adolescents with chronic and immunosuppressive conditions in a tertiary university hospital during the COVID-19 pandemic

Lavorato¹,

Helito²,

Barros³

et al. 2021

Clinics

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Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children

Katlan

Kesici

Karacanoğlu

et al. 2022

J of Clinical Apheresis

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Background Multisystem inflammatory syndrome in children (MIS‐C) can be life threatening in severe cases because of uncontrolled inflammation and multi‐organ failure. In this study, we report the effect of plasma exchange in the treatment of MIS‐C and to emphasize the effect of its early application on outcome. Method In this retrospective observational study, the medical records of children with severe MIS‐C admitted to pediatric intensive care unit (PICU) between April 2020 and January 2021 were reviewed. Severe MIS‐C patients were treated according to protocol consisting of plasma exchange (PE), intravenous immune globulin, steroids, and anakinra which we called the “PISA” protocol referring to the initials. The patients were divided into two groups as early plasma exchange (E‐PE) and late plasma exchange (L‐PE) according to the elapse time between hospital admission and the administration of PE. Groups were compared in terms of outcome variables. Primary study outcome was 28‐day mortality. Secondary outcome variables were acute phase response time, length of immunomodulatory treatment, frequency of patients requiring mechanical ventilation (MV) and inotropic support, length of inotropic support and MV, length of hospital and PICU stays. Results Eighteen pediatric patients with MIS‐C were included in the study. Seventeen (95%) of the patients presented with decompensated shock and required inotropic support. One of the 17 patients needed extracorporeal membrane oxygenation support (ECMO) PISA protocol was used in all patients. There was no mortality in the E‐PE group while the mortality rate was 20% in the L‐PE group. Acute phase reactant response was faster in the E‐PE group and immunomodulatory treatments could be reduced earlier; the frequency of patients requiring inotropic and mechanical ventilation (MV) support was lower in the E‐PE group; the duration of inotropic support, duration of MV, and length of stay in hospital and PICU were significantly shorter in the E‐PE group. Conclusion We suggest that in selected cases, timely administration of PE is a beneficial rescue therapy for MIS‐C related hyperinflammation presenting with severe cardiovascular collapse.

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

Cited by 74 publications

References 30 publications

The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

Assistance and health care provided to adolescents with chronic and immunosuppressive conditions in a tertiary university hospital during the COVID-19 pandemic

Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children

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