Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | (No./%) |
---|---|
Mean Age (years ± SD) | 6.8 ± 4.6 |
Males | 21 (61.76%) |
Urban area | 20 (58.82%) |
Caucasian | 34 (100%) |
Known SARS-CoV-2 infection | 3 (8.82%) |
Recent contact SARS-CoV-2 | 12 (32.35%) |
Cardiac manifestations tachycardia mild myocardial dysfunction (LVEF between 30–55%) severe myocardial dysfunction (LVEF less than 30%) hypotension shock with a vasopressor requirement arterial hypertension Kawasaki disease like coronary dilatation/aneurysm pericardial effusion abnormalities on echocardiogram or dysrhythmia | 26 (74.47%) 25 (73.52%) 7 (20.58%) 2 (5.88%) 9 (26.47%) 4 (11.76%) 2 (5.88%) 3 (8.82%) 5 (14.70%) 9 (26.47%) 1 (2.94%) |
Gastrointestinal symptoms: gastroenteritis acute hepatitis acute liver failure sludge in the gallbladder biliary hydrops false appendicitis mesenteric adenitis ascites | 27 (79.41%) 17 (50.00%) 5 (14.70%) 1 (2.94%) 4 (11.76%) 1 (2.94%) 5 (14.70%) 4 (11.76%) 4 (11.76%) |
Neurological symptoms: headache vision troubles marked drowsiness meningism encephalitis | 24 (70.59%) 6 (17.64%) 2 (5.88%) 14 (41.17%) 2 (5.88%) 1 (2.94%) |
Respiratory symptoms (pneumonia, hypoxia) | 13 (38.24%) |
Hematological manifestations: leukopenia thrombocytopenia anemia bicytopenia pancytopenia macrophage activation syndrome hemophagocytic lymphohistiocytosis syndrome | 26 (76.74%) 13 (38.24%) 13 (38.23%) 18 (52.94%) 7 (20.58%) 5 (5.88%) 1 (2.94%) 1 (2.94%) |
Mucocutaneous damage: rash peeling of skin around fingernails and toenails conjunctivitis mucositis | 22 (64.71%) 12 (35.29%) 5 (14.70%) 21 (61.76%) 5 (14.70%) |
Acute kidney injury | 7 (20.59%) |
Rheumatic symptoms arthralgia/arthritis myalgia | 13 (38.24%) 3 (8.82%) 6 (17.64%) |
Other symptoms: fever shivering asthenia edema | 34 (100%) 8 (23.53%) 29 (85.29) 10 (29.41%) |
Children admitted to the Pediatric Intensive Care Unit | 12 (35.29%) |
Clinical Parameters and Laboratory Tests (Normal Range) | MIS-C (n = 34) | MIS-C Severity | ||
---|---|---|---|---|
Mild Form (n = 15, 44.11%) | Severe Form (n = 19, 55.88%) | p-Value | ||
Mean Age (years ±SD) | 6.8 ± 4.6 | 6.7 ± 10.3 | 5.3 ± 2.08 | 0.554111 |
Male (No., %) | 21 (61.76%) | 8 (53.33%) | 13 (68.42%) | 0.3758 |
The period between the onset of symptoms and the first day of hospitalization (days ± SD) | 6.7 ± 7.2 | 8.4 ± 10.5 | 5.3 ± 2.1 | 0.219357 |
Duration of hospitalization (days ± SD) | 11.6 ± 8.0 | 6.9 ± 2.6 | 15.3 ± 8.9 | 0.001202 |
Growth (Z-score ± SD) | −0.5 ± 2.1 | −1.0 ± 2.8 | −0.1 ± 1.3 | 0.222802 |
Duration of fever (days ± SD) | 4.3 ± 2.9 | 7.5 ± 2.8 | 0.003500 | |
CBC WBC (4.2–9.4×103/μL) Hb (10–13 g/dL) P (194–345×103/μL) | 11.440.2 ± 5578.6 11.5 ± 1.7 253.147.3 ± 162.799.0 | 12.155 ± 5.538 12.1 ± 0.0 347.800 ± 162.062 | 10.875 ± 5.694 11.1 ± 2.0 178.421 ± 121.662 | 0.514972 0.106651 0.001456 |
Inflammatory markers ESR (0–20 mm/h) ESR max (mm/h) | 34.6 ± 19.6 | 36.2 ± 20.4 43.8 ± 18.1 | 33.3 ± 19.4 50.6 ± 25.8 | 0.671182 0.391620 |
CRP (0–1 mg/L) CRP max (mg/L) | 12.1 ± 7.4 | 8.2 ± 6.0 10.0 ± 5.8 | 15.1 ± 7.0 16.8 ± 6.1 | 0.004433 0.002503 |
Procalcitonin (<0.8 g/dL) Procalcitonin max (g/dL) | 6.3 ± 15.6 | 1.7 ± 2.7 1.9 ± 2.8 | 10.0 ± 20.2 11.7 ± 20.1 | 0.122764 0.072844 |
Ferritin (<300 ng/mL) LDH (120–330 g/L) (n = 29) IL-6 (<5 pg/mL) (n = 25) | 763.7 ± 2274.9 24 ± 334.5 | 179.1 ± 270.9 259.9 ± 64.2 33.7 ± 22.9 | 1227.1 ± 2986.5 380.5 ± 277.4 214.8 ± 385.8 | 0.186437 0.122081 0.176261 |
Hepatic function AST (10–37 U/L) ALT (9–40 U/L) Albumin (3.9–5.2 g/dL) | 102.5 ± 325.5 100.5 ± 358.7 3.4 ± 0.6 | 45.3 ± 36.5 37.9 ± 42.3 3.8 ± 0.5 | 147.6 ± 433.9 150.0 ± 478.2 3.1 ± 0.5 | 0.370580 0.373564 0.001963 |
Renal function Urea (5–18 mg/dL) Creatinine (<1.0 mg/dL) | 27.6 ± 13.1 0.4 ± 0.2 | 23.3 ± 8.5 0.4 ± 0.2 | 31.0 ± 15.2 0.5 ± 0.3 | 0.086228 0.316754 |
Coagulopathy Fibrinogen (200–400 mg/dL) D-dimers (250 ng/mL) | 429.3 ± 129.0 2488.4 ± 3459.0 | 460.4 ± 124.5 1389.9 ± 1359.4 | 404.5 ± 130.3 3297.9 ± 4278.5 | 0.224362 0.118825 |
Cardiac markers NT-proBNP (<125 pg/mL) Troponin (<35 ng/L) | 3998.9 ± 7231.7 18 ± 27.9 | 288.2 ± 416.9 2.6 ± 0.4 | 6733.2 ± 8.616.6 28.6 ± 32.4 | 0.009057 0.007231 |
Other CK (8–147 U/L) TGL (<150 mg/dL) | 52 ± 38 173.6 ± 114.7 | 49.4 ± 30.6 116.3 ± 56.4 | 53.8 ± 43.0 218.8 ± 129.5 | 0.764305 0.007515 |
Glycemia, electrolytes Glucose (60–99 mg/dL) Na (134–143 mEq/L) K (3.4–4.7 mEq/L) | 105.7 ± 42.9 135.9 ± 4.1 4.1 ± 0.5 | 91.9 ± 16.6 137.9 ± 2.9 4.3 ± 0.4 | 116 ± 53.6 134.3 ± 4.3 4.0 ± 0.6 | 0.095998 0.008941 0.067727 |
Cohort Characteristics (n = 34 Cases) | Mild Disease Form (n = 15 Cases) | Severe Disease Form (n = 19 Cases) | p-Value | |
---|---|---|---|---|
Multiorgan Disfunction * | Organ Disfunction Number 2–3 organs 4–5 organs 6–8 organs >8 organs | 9 (60%) 6 (40%) 0 0 | 1 (5.26%) 4 (21.06%) 10 (52.64%) 4 (21.06%) | 0.0026 0.2358 0.0010 0.0623 |
Laboratory parameters impairment | Inflammatory markers Increased ESR (>20 mm/h) Increased CRP (>1 mg/L) Increased procalcitonin (>1 g/dL) Increased Ferritin (>300 ng/mL) Increased LDH (>330 g/L) Increased IL-6 (>5 pg/mL) | 11 (73.34%) 13 (86.67%) 3 (20%) 1 (6.67%) 15 (100%) 7 (n = 9; 77.77%) | 19 (100%) 19 (100%) 19 (100%) 13 (68.43%) 19 (100%) 16 (n = 16; 100%) | 0.0183 0.1061 <0.0001 0.0003 - 0.0540 |
Hepatic dysfunction Increased AST (>45 U/L) Increased ALT (>50 U/L) Hypoalbuminemia (<3 g/dL) | 2 (13.34%) 2 (13.34%) 3 (20%) | 5 (26.32%) 5 (26.32%) 15 (78.95%) | 0.3599 0.3599 0.0008 | |
Renal dysfunction Increased Urea (>25 mg/dL) Increased Creatinine (>1.0 mg/dL) | 12 (80%) 0 | 18 (94.74%) 3 (15.79%) | 0.1919 0.1123 | |
Coagulopathy Increase Fibrinogen (>400 mg/dL) Increased D-dimers (>250 ng/mL) | 9 (60%) 10 (66.67%) | 12 (63.16%) 19 (100%) | 0.8529 0.0073 | |
Cardiac dysfunction Increased NT-proBNP (>150 pg/mL) Increased Troponin (>35 ng/L) | 9 (60%) 0 | 19 (100%) 7 (36.85%) | 0.0028 0.0093 | |
Other Increased CK (>200 U/L) Increased TGL (>150 mg/dL) | 0 3 (20%) | 1 (5.26%) 13 (68.43%) | 0.3744 0.0056 | |
Glycemia, electrolytes Hypoglycemia (<60 mg/dL) Hyponatremia (<130 mEq/L) Hypernatremia (>145 mEq/L) Hypokalemia (<3 mEq/L) Hyperkalaemia (>5 mEq/L) | 0 0 0 0 5 (33.34%) | 0 7 (36.85%) 0 3 (15.79%) 11 (57.89%) | - 0.0093 - 0.1123 0.1605 | |
Long-term evolution | Completely recovery Partial recovery (chronic complications) Death | 15 (100%) 0 0 | 12 (63.16%) 7(36.85%) 1 (5.26%) | 0.0094 0.0093 0.7020 |
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Grama, A.; Căinap, S.S.; Mititelu, A.; Blag, C.; Simu, C.; Burac, L.; Simionescu, B.; Mărgescu, C.; Sur, G.; Spârchez, M.; et al. Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience. J. Clin. Med. 2022, 11, 5256. https://doi.org/10.3390/jcm11185256
Grama A, Căinap SS, Mititelu A, Blag C, Simu C, Burac L, Simionescu B, Mărgescu C, Sur G, Spârchez M, et al. Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience. Journal of Clinical Medicine. 2022; 11(18):5256. https://doi.org/10.3390/jcm11185256
Chicago/Turabian StyleGrama, Alina, Simona Sorana Căinap, Alexandra Mititelu, Cristina Blag, Claudia Simu, Lucia Burac, Bianca Simionescu, Camelia Mărgescu, Genel Sur, Mihaela Spârchez, and et al. 2022. "Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience" Journal of Clinical Medicine 11, no. 18: 5256. https://doi.org/10.3390/jcm11185256
APA StyleGrama, A., Căinap, S. S., Mititelu, A., Blag, C., Simu, C., Burac, L., Simionescu, B., Mărgescu, C., Sur, G., Spârchez, M., Bota, M., Tănasă, B., & Pop, T. L. (2022). Multisystemic Inflammatory Syndrome in Children, A Disease with Too Many Faces: A Single-Center Experience. Journal of Clinical Medicine, 11(18), 5256. https://doi.org/10.3390/jcm11185256