ABSTRACT
Background and Aim: Multisystem inflammatory syndrome in chil-dren (MIS-C) is a late manifestation of SARS-CoV-2 infection. Cardiac involvement is common and presents as ventricular dys-function, shock, and coronary anomalies. The aim of the study is evaluate the influence of cardiac disfunction on clinical presen-tations and outcomes in a single center. Method(s): A retrospective study on patients diagnosed with MIS-C and referred to Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were treated with intravenous immunoglobulins, corticosteroids and anti-throm-botic prophylaxis, in respect to our approved multidisciplinary protocol. According to the admission cardiac left ventricular ejec-tion fraction (LVEF), the patients were divided into group A (LVEF lt;45%) and group B (LVEF >=45%). Result(s): We collected 32 consecutive patients. Group A included 10 patients (9M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15M/7M, aged 9 years [IQR 7-13]). At the presentation, significant differences were observed among shock (group A 6/10 vs group B 2/22, plt;0.01), gastrointestinal involvement (9/10 vs 11/22, p = 0.04) and duration of fever (5.3 vs 6.9 days, p = 0.02). All patients in group A required inten-sive care hospitalization (10/10 vs 12/22, p = 0.01). Interestingly, despite good cardiac function, two patients in group B presented with shock, probably due to vasoplegic/distributive cardiocircula-tory impairment secondary to the inflammatory state. Among biochemistry parameters, leukocytes, neutrophils, and CRP were significantly worse in group A (p = 0.001, p = 0.001 and p = 0.008, respectively). Pathological level of troponin T and NTproBNP were detected in all patients in group A and also in 33% and 77% of group B;with statistically significant higher median values in group A (Troponin T 72 [40-243] ng/L vs 22 [8-49] ng/L, p = 0.01;NTproBNP 14825 [11340-17810] ng/L vs 5921 [1114-11243] ng/L, p = 0.01). In group A, mitral regurgitation was more frequent (plt;0.01) and one patient had transient left main coronary dilation (Boston z-score +2.39). At the discharge, cardiac function normalized in all patients. Total length of hospital stay and cardiac recovery time were not statistically different between groups. Conclusion(s): If correctly diagnosed and early treated, all the MIS-C patients completely recovered, regardless of the initial cardiac involvement.
ABSTRACT
Introduction: Multisystem Inflammatory Syndrome in children (MISC) was initially described during the first phase of COVID-19 pandemic as a severe clinical condition with systemic inflammation and multi-organ involvement. Many patients show features of Kawasaki Disease. Cardiac involvement, from myocarditis to coronary abnormalities, is a key feature of the syndrome, but there are still little data concerning the long-term outcome in these patients. Objectives: The aim of our study was to evaluate long-term cardiac outcome in patients diagnosed with MIS-C during the first phase of COVID-19 pandemic in Italy. Methods: We previously published the results of the Italian multicenter survey of MIS-C, launched by the Rheumatology Study Group of Italian Pediatric Society during the first wave of COVID-19 pandemic. For each patient who received MIS-C diagnosis, we collected demographic, clinical, laboratory data, imaging findings, and treatment information in an online anonymized database (RedCAP). Data collection included all the admission period and all follow/up visits. For the purpose of this study, we analyzed all patients with at least 3months of follow/up mainly focusing on heart involvement. Results: Fifty-three patients who received MIS-C diagnosis between February 1st and May 31st 2020 were included in our study. The median age at diagnosis was 7 years (IQR 4,5-11). Forty-one patients showed cardiac involvement during the course of the disease. Treatment with IVIG was reported in 66% of patients at diagnosis and glucocorticoids in 56,6%. Four patients received treatment with IL-1 receptor antagonist (anakinra) and one with hydroxychloroquine. Use of vasoactive agents was reported in 20,8% of patients. No case of death was reported in our population. Data on cardiac outcome were available for 33 patients after a median time of follow-up of 6 months (IQR 7.2- 4.08). Twenty-eight out of 33 patients presented a cardiac involvement during hospitalization for MIS-C: 17 had myocarditis, 5 had pericarditis, 3 coronary artery abnormalities, 8 heart failure, 9 valvular insufficiency, 11 shock or hypotension. For each patient cardiac outcome was assessed by heart ultrasonography. At the end of our follow-up period only four patients still had heart abnormalities: all of them presented mild valvular insufficiency and 2 patients still had ultrasonographic signs of hypokinesia. None of them was on medication. Conclusion: MIS-C is an emerging inflammatory condition that spreads among the pediatric population in parallel to SARS-CoV2 pandemic. The disease is frequently complicated by cardiological involvement but, differently to Kawasaki disease, myocarditis and shock are the most common complications. As we reported in our previous study, short-term outcome is usually good in children with MIS- C and heart involvement. With this study we also provide a long-term cardiac follow-up and we showed that only a minority of patients with previous cardiac involvement presented minor heart abnormalities. Furthermore, no patients developed new heart disease during follow-up.
ABSTRACT
PURPOSE: COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS: We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS: Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS: A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.