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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.

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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

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

Autores: 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

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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.

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