Indexed in

License and use

Citations

Cited 120 times in

Cited 109 times in

Cited 82 times in

Cited 122 times in

Altmetrics

Grant support

This study has been founded by the Carlos III Health Institute (ISCIII) through the COVID-19 found. Ref. COV20-00944. The founder had no role in study design, data collection, analysis and interpretation.

Analysis of institutional authors

Share

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

Publicated to:CRITICAL CARE. 24 (1): 666- - 2020-12-26 24(1), DOI: 10.1186/s13054-020-03332-4

Authors: Garcia-Salido, Alberto; de Carlos Vicente, Juan Carlos; Belda Hofheinz, Sylvia; Balcells Ramirez, Joan; Slocker Barrio, Maria; Leoz Gordillo, Ines; Hernandez Yuste, Alexandra; Guitart Pardellans, Carmina; Cuervas-Mons Tejedor, Maite; Huidobro Labarga, Beatriz; Vazquez Martinez, Jose Luis; Gutierrez Jimeno, Miriam; Oulego-Erroz, Ignacio; Trastoy Quintela, Javier; Medina Monzon, Carmen; Medina Ramos, Laura; Holanda Pena, Maria Soledad; Gil-Anton, Javier; Sorribes Orti, Clara; Flores Gonzalez, Jose Carlos; Hernandez Palomo, Rosa Maria; Sanchez Ganfornina, Inma; Fernandez Romero, Emilia; Garcia-Besteiro, Maria; Lopez-Herce Cid, Jesus; Gonzalez Cortes, Rafael

Affiliations

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.

Keywords