Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.

BACKGROUND: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT: MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center.

OBJECTIVES: Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition resulting in excessive response of the immune system after SARS-CoV-2 infection. We report a single-center cohort of children with MIS-C, describing the spectrum of presentation, therapies, clinical course, and short-term outcomes. METHODS: This is a prospective observational study from to a tertiary pediatric rheumatology center including patients (aged 1 month to 21 years) diagnosed with MIS-C between April 2020-April 2021. Demographic, clinical, laboratory results and follow-up data were collected through the electronic patient record system and analyzed. RESULTS: A total of 67 patients with MIS-C were included in the study. Fever was detected in all patients; gastrointestinal system symptoms were found in 67.2% of the patients, rash in 38.8%, conjunctivitis in 31.3%, hypotension in 26.9% myocarditis, and/or pericarditis in 22.4%, respectively. Respiratory symptoms were only in five patients (7.5%). Kawasaki Disease like presentation was found 37.3% of the patients. The mean duration of hospitalization was 11.8 7.07 days. Fifty-seven patients (85%) received intravenous immunoglobulin (IVIG), 45 (67%) received corticosteroids, 17 (25.3%) received anakinra, and one (1.5%) received tocilizumab. Seven of the patients (10.4%) underwent therapeutic plasma exchange (TPE). In 21 (31.3%) patients, a pediatric intensive care unit (PICU) was required in a median of 2 days. The first finding to improve was fever, while the first parameter to decrease was ferritin (median 6.5 days (IQR, 4-11.2 days)). Sixty-five patients were discharged home with a median duration of hospital stay of 10 days (IQR, 7-15 days). CONCLUSION: Patients with MIS-C may have severe cardiac findings and intensive care requirements in admission and hospital follow-up. The vast majority of these findings improve with effective treatment without any sequelae until discharge and in a short time in follow-up. Although the pathogenesis and treatment plan of the disease are partially elucidated, follow-up studies are needed in terms of long-term prognosis and relapse probabilities.

Akut Batın kliniği ile başvuran COVID-19 ilişkili pediatrik multisistemik inflamatuvar sendrom (MIS-C) olgusunda plazmaferez tedavi etkinliği

Etkeni “Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2)” olarak isimlendirilen “Coronavirus Disease 2019 (COVID-19)” 11 Mart 2020 tarihinde Dünya Sağlık Örgütü tarafından salgın olarak ilan edilmiştir. Çocuklarda COVID-19 genellikle hafiftir. Nadir durumlarda çocuklar ciddi şekilde etkilenebilir ve klinik yetişkinlerden farklı olabilir. 2020 yılı mayıs ayından itibaren dünyanın çeşitli bölgelerinden çocuk olgular rapor edilmiş ve Dünya Sağlık Örgütü bu olguları pediatrik multisistemik inflamatuvar sendrom olarak tanımlamıştır. Bu yazıda, sekiz yaşında, ateş ve karın ağrısı yakınmaları ile hastaneye başvuran, akut apandisit tanısı ile çocuk cerrahi tarafından opere edilen, multisistemik inflamatuvar sendrom kliniği ile çocuk yoğun bakım ünitesinde izlenerek intravenöz immünglobulin, steroid, plazmaferez tedavileri ve inotrop destek yapılan bir olgu sunulmuştur. Bu olgu ile COVID-19 pandemisinde çocukluk yaş grubunda farklı klinik prezentasyonlarla hastane başvurusu olabileceği, özellikle yoğun bakım ihtiyacı olan multisistemik inflamatuvar sendrom olgularında intravenöz immünglobulin ve plazmaferez tedavi kombinasyonunun kullanılmasının hayat kurtarıcı bir şeçenek olabileceği vurgulanmak istenmiştir.Alternate abstract: In March 2020, the World Health Organization designated the disease Coronavirus Disease 2019 (COVID-19), which caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), as a pandemic. Prognosis of the disease proceed generally mildly in pediatric cases. Rarely, children have been affected severely and prognosis can be different from adult patients. Since May 2020, reports from different countries documented a presentation in children and this condition has been termed as multisystem inflammatory syndrome in children. This report, we presented an 8-year-old patient who was admitted to the hospital with complaints of fever and abdominal pain, was operated by a pediatric surgeon with the diagnosis of acute appendicitis, was followed up with the multisystemic inflammatory syndrome clinic in pediatric intensive care unit, and received intravenous immunoglobulin, steroid, plasmapheresis treatments and inotropic support. This report, we wanted to emphasize that in the COVID-19 pandemic, there may be hospital applications with different clinical presentations in the childhood age group, and the use of intravenous immunoglobulin and plasmapheresis treatment combinati

The Role of Therapeutic Plasma Exchange (TPE) in Multisystem Inflammatory Syndrome in Children (MIS-C).

Multisystemic inflammatory syndrome in children (MIS-C) is a new potentially life-threatening disease that is related to coronavirus disease 2019 (COVID-19). The aim of this study is to reveal the clinical and laboratory results of MIS-C and the role of therapeutic plasma exchange (TPE) in its treatment. Clinical, laboratory and radiological characteristics of the patients who were admitted to the pediatric ward and pediatric intensive care unit (PICU) of a tertiary hospital with a diagnosis of MIS-C between April 2020 and March 2021 were included in the study. Forty-one patients were admitted to our hospital with a diagnosis of MIS-C. Twenty-one (51.2%) patients were admitted to the PICU. Six patients needed invasive mechanical ventilation (14.6%), 10 patients (24.4%) TPE and 3 patients (7.3%) needed extracorporeal membrane oxygenation (ECMO). The patients were grouped according to need for PICU admission (Group 1: no need for PICU, Group 2: need for PICU admission). Group 2 had significantly higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), ferritin, D-dimer, pro-B type natriuretic peptide (pro BNP) and lactate (p < 0.05). Hyponatremia found to be an independent risk factor for inpatient MIS-C in the PICU. We think that dynamic laboratory trending is beneficial in determining the need for PICU admission and TPE may be effective in critically ill patients.