ABSTRACT
Introduction and objectives: SARS-CoV 2 infection has spread throughout the world and affects patients of all ages. Until recently it was thought that children had a short course of the disease without complications;however, a group of children with severe multisystem disease known as pediatric inflammatory multisystem syndrome (PIMS or MIS-C), characterized by fever and multiple organ dysfunction were found to be associated with infection SARS-CoV 2 and development of COVID-19. An increase in the association of gastrointestinal symptoms and the presence of PIMS has been observed. The objective of this study was to analyze whether pediatric patients with COVID-19, who debut with gastrointestinal symptoms, have a higher risk of developing PIMS. Material(s) and Method(s): An observational, analytical and retrolective study was carried out with a review of the records of patients diagnosed with COVID-19 from April 27th, 2020, to May 9th, 2021. All pediatric patients who had a positive test for SARS-CoV 2 (RT- PCR test for SARS-CoV 2, by QUANT STUDIO 5 applied biosystems by Thermo Fisher equipment) were included, those patients who did not have laboratory results for acute phase reactants during their hospitalization were excluded. PIMS/MIS-C was defined according to the CDC criteria, which include patients under 21 years of age with fever greater than 38.0, with involvement of two or more organs or systems, with elevated acute phase reactants (ESR / CRP / Ferritin);which were determined as high according to the values established by the local hospital laboratory;as well as not having another disease that explains the patient's symptoms. In order to identify every patient with/without PIMS/MIS-C a thorough search through patient's files was conducted. With the objective of determining if every patient fulfilled the criteria established for PIMS/MIS-C and determine the cause of admission, as well as the presence of other factors that could influence or discard the diagnosis of PIMS/MISC as according to CDC criteria, excluding those patients with initial suspicion of PIMS/MIS-C that had other diseases that explained the symptoms at admission or during hospital stay. Normally distributed variables are summarized as the mean and standard deviation, data from skewed distributions are shown as the median (range), and categorical variables are summarized as frequency and percentages. A (two-tailed) P value<0.05 was considered to be significant. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed for significant categorical variables. Given the retrospective nature of the study, informed consent was not required. Result(s): A total of 248 patients who met the selection criteria were included. Of Those 40% were female, with a mean age of 7 +/- 5.8 years. Although it wasn't possible to determine the strain of SARS-CoV 2 in our institution until after our study was finished (October 2021), based on epidemiological data we can assume our patients were infected with the Delta strain of the SARS-CoV 2 virus. Gastrointestinal symptoms were the initial presentation in 103 patients, with vomiting being the most frequent symptom, followed by abdominal pain and diarrhea. In total 52 patients developed PIMS, 30 of whom presented with gastrointestinal symptoms. The comparison of patient's characteristics, comorbidities and biometric laboratory results can be found in table 1. An OR of 2.35 (97% CI of 1.26-4.37) was found for the presentation of PIMS in patients positive for SARS-CoV 2 who present with gastrointestinal symptoms. Conclusion(s): There is an increased risk of developing pediatric multisystem inflammatory syndrome when there are gastrointestinal symptoms in pediatric patients with COVID-19. (Table Presented).