ABSTRACT
BACKGROUND AND AIM: The multisystem inflammatory syndrome in children (MIS-C) is a new entity and needs data to study its evolution. To describe the clinicolaboratory profile, intensive care needs, and outcome of MIS-C during the first and second waves. METHOD(S): Retrospective analysis of 122 children with MIS-C admitted to Pediatric emergency and PICU of a tertiary-teaching hospital during first and second wave of Covid-19. RESULT(S): Median (IQR) age was 7 (4-10) years with 67% boys. Common manifestations included fever (99%), abdominal symptoms (81%), rash (66%), conjunctival injection (65%), oral mucosa and respiratory involvement (43% each). Elevated CRP (97%), D-dimer (89%), procalcitonin (80%), IL-6 (78%), ferritin (56%), NT-pro- BNP (84%), and positive SARS-CoV-2 antibody (81%) were common laboratory abnormalities. Cardiovascular manifestations included myocardial dysfunction (55%), shock (48%), and coronary artery changes (10%). The treatment included intensive care support (57%), non-invasive (33%) and invasive (18%) ventilation, vasoactive drugs (47%), IVIG (83%), steroids (85%), and aspirin (87%). Mortality was 5% (n=6). Duration of hospital stay was 5 (3-8) days. During second wave, significantly higher proportion had positive SARS-CoV-2 antibody, contact with COVID-19 case, and oral mucosal changes;lower markers of inflammation (CRP, procalcitonin, ferritin, and IL-6);lower rates of shock, myocardial dysfunction, and coronary artery changes;lesser need of PICU, vasoactive drugs, and IVIG;and shorter hospital stay. CONCLUSION(S): MIS-C is febrile multisystemic disease characterized by hyperinflammation, cardiovascular involvement, relationship to SARS-CoV-2, and good outcome with immunomodulation and intensive care. During the second wave, the severity of illness, degree of inflammation, and intensive care needs was lesser.
ABSTRACT
INTRODUCTION: Severe pneumonia is a common indication for admission to the pediatric intensive care unit (PICU) and a leading cause of morbidity and mortality. The lack of epidemiology and outcome data from Asia is a barrier to improving outcomes of severe pneumonia in the region. METHOD(S): This is a prospective multicenter cohort study carried out from April 2019 to April 2022. Fifteen PICUs participated in this study under the Pediatric Acute & Critical Care Medicine Asian Network. Epidemiological, microbiological and outcome data were collected up to hospital discharge. Univariate logistic regression analysis were conducted to explore the association between potential risk factors and severe outcomes [acute respiratory distress syndrome (ARDS) and PICU mortality]. Multivariable analysis was performed withforward stepwise logistic regression adjusted for sites and COVID-19 pandemic including variables with p< 0.05 in univariate model. RESULT(S): There were 786 children with severe pneumonia in PICU with mean (standard deviation) age 2.8 (3.9) years. 384/786 (48.9%) had comorbidities;126/786 (16.0%) had a history of prematurity (gestational age < 37 weeks). Admission Pediatric Index of Mortality 3 (PIM3) and Pediatric Logistic Organ Dysfunction 2 (PELOD2) score were 16.2 (22.9) and 4.1(4.6). A sole viral or bacterial pathogen was identified in 179/786 (22.4%) and 165/786 (21.0%). Co-infections occurred in 114/786 (14.5%) patients. ARDS and mortality occurred in 156/786 (20.1%) and 70/786(8.9%) patients. In the multivariable model, risk factors for ARDS included PIM3 [adjusted odds ratio (aOR) [95% confidence interval (CI)] of 1.02 (1.01, 1.03)], PELOD2 [aOR 1.08 (95%CI 1.02, 1.13)] and involvement of 4 quadrants on chest-x-ray, [aOR 2.69 (95%CI 1.39, 5.18)]. Risk factors for mortality included PIM 3 [aOR 1.03 (95%CI 1.01, 1.04)], involvement of 4 quadrants on chest-x-ray [aOR 2.72 (95%CI 1.10, 6.73)], bacterial [aOR 2.61 (95%CI 1.00, 6.82)], fungus or mycobacterium [aOR 12.30 (95%CI 1.45, 104.57)] and co-infections [aOR 2.72 (95%CI 1.10, 10.35)]. CONCLUSION(S): The rate of ARDS and mortality in severe pneumonia admitted to PICU in Asia was high. Risk factors for poor outcomes were admission severity scores, generalized X-ray involvement and identification of bacteria, fungus/mycobacteria or co-infections.