@misc{10498/24269,
year = {2020},
month = {12},
url = {http://hdl.handle.net/10498/24269},
abstract = {Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.},
publisher = {BMC},
keywords = {SARS-CoV-2},
keywords = {Pediatric multisystem inflammatory syndrome temporally associated with COVID-19},
keywords = {Kawasaki disease},
keywords = {Toxic shock syndrome},
keywords = {Children},
keywords = {Critical care},
keywords = {Shock},
title = {Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain},
doi = {10.1186/s13054-020-03332-4},
author = {García‑Salido, Alberto and de Carlos Vicente, Juan Carlos and Hofheinz, Sylvia Belda and Balcells Ramírez, Joan and Slöcker Barrio, María and Leóz Gordillo, Inés and Hernández Yuste, Alexandra and Guitart Pardellans, Carmina and Cuervas‑Mons Tejedor, Maite and Huidobro Labarga, Beatriz and Vázquez Martínez, José Luis and Gutiérrez Jimeno, Miriam and Oulego‑Erróz, Ignacio and Trastoy Quintela, Javier and Medina Monzón, Carmen and Medina Ramos, Laura and Holanda Peña, María Soledad and Gil‑Antón, Javier and Sorribes Ortí, Clara and Flores González, José Carlos and Hernández Palomo, Rosa María and Sánchez Ganfornina, Inma and Fernández Romero, Emilia and García‑Besteiro, María and López‑Herce Cid, Jesús and González Cortés, Rafael and Spanish Pediatric Intensive Care Society working group on SARS‑CoV‑2 infection},
}