ABSTRACT
This is a multicentre prospective cohort including critically ill children and adolescents, with confirmed critical disease related to SARS-CoV-2, admitted to three tertiary paediatric intensive care units in the Brazilian Amazon, between April 2020 and July 2022. 208 patients were included (median age was 3.5 years). The majority had malnutrition (62%) and comorbidities (60.6%). Mechanical ventilation support, cardiogenic shock and acute respiratory distress syndrome occurred in 47%, 30% and 34.1% of patients, respectively. There were 37 (18%) deaths. A poor outcome of severe COVID-19 and multisystem inflammatory syndrome in children was observed in children and adolescents from the Brazilian Amazon.
Subject(s)
COVID-19 , Adolescent , Humans , Child , Child, Preschool , COVID-19/epidemiology , SARS-CoV-2 , Prospective Studies , HospitalizationABSTRACT
OBJECTIVE: To assess the performance of Pediatric Risk of Mortality (PRISM) III and Pediatric Index of Mortality (PIM) 2 scores in the pediatric intensive care unit. METHODS: A retrospective cohort study. Data were retrospectively collected from medical records of all patients admitted to the pediatric intensive care unit of a cancer hospital from January 2017 to June 2018. RESULTS: The mean PRISM III score was 15, and PIM 2, 24%. From the 338 studied patients, 62 (18.34%) died. The PRISM III estimated mortality was 79.52 patients (23.52%) and for PIM 2 80.19 patients (23.72%), corresponding to a standardized mortality ratio (95% confidence interval: 0.78 for PRISM II and 0.77 for PIM 2). The Hosmer-Lemeshow chi-square test was 11.56, 8df, 0.975 for PRISM II and 0.48, 8df, p = 0.999 for PIM 2. The area under the Receiver Operating Characteristic curve was 0.71 for PRISM III and 0.76 for PIM 2. CONCLUSION: Both scores overestimated mortality and have shown a regular ability to discriminate between survivors and non-survivors. Models should be developed to quantify the severity of cancer pediatric patients in Pediatric Intensive Care Units and to predict the mortality risk accounting for their peculiarities.
OBJETIVO: Avaliar o desempenho do Pediatric Risk of Mortality (PRISM) III e do Pediatric Index of Mortality (PIM) 2 em unidade de terapia intensiva pediátrica. MÉTODOS: Estudo de coorte retrospectivo. Os dados retrospectivos foram coletados dos prontuários de todos os pacientes admitidos na unidade de terapia intensiva pediátrica de um hospital infantil oncológico, entre janeiro de 2017 a junho de 2018. RESULTADOS: A média do PRISM III foi de 15 e do PIM 2 de 24%. Dos 338 pacientes estudados, 62 (18,34%) morreram. A mortalidade estimada pelo PRISM III foi de 79,52 (23,52%) e pelo PIM 2 de 80,19 (23,72%) pacientes, correspondendo a taxa padronizada de mortalidade (intervalo de confiança de 95%) de 0,78 para o PRISM II e 0,77 para o PIM 2. O teste de ajuste de Hosmer-Lemeshow obteve qui-quadrado de 11,56, 8df, com p = 0,975, para PRISM III, e qui-quadrado de 0,48, 8df, p = 0,999, para o PIM 2. Foi obtida área sob a curva Característica de Operação do Receptor de 0,71 para o PRISM III e 0,76 para o PIM 2. CONCLUSÃO: Os dois escores superestimaram a mortalidade e demonstraram poder regular de discriminação entre sobreviventes e não sobreviventes. Devem ser desenvolvidos modelos para quantificar a gravidade de pacientes pediátricos com câncer em unidade de terapia intensiva pediátrica e predizer o risco de mortalidade que contemplem suas peculiaridades.
Subject(s)
Critical Illness , Neoplasms , Child , Hospital Mortality , Humans , Infant , Intensive Care Units, Pediatric , Prospective Studies , Retrospective Studies , Severity of Illness IndexABSTRACT
RESUMO Objetivo: Avaliar o desempenho do Pediatric Risk of Mortality (PRISM) III e do Pediatric Index of Mortality (PIM) 2 em unidade de terapia intensiva pediátrica. Métodos: Estudo de coorte retrospectivo. Os dados retrospectivos foram coletados dos prontuários de todos os pacientes admitidos na unidade de terapia intensiva pediátrica de um hospital infantil oncológico, entre janeiro de 2017 a junho de 2018. Resultados: A média do PRISM III foi de 15 e do PIM 2 de 24%. Dos 338 pacientes estudados, 62 (18,34%) morreram. A mortalidade estimada pelo PRISM III foi de 79,52 (23,52%) e pelo PIM 2 de 80,19 (23,72%) pacientes, correspondendo a taxa padronizada de mortalidade (intervalo de confiança de 95%) de 0,78 para o PRISM II e 0,77 para o PIM 2. O teste de ajuste de Hosmer-Lemeshow obteve qui-quadrado de 11,56, 8df, com p = 0,975, para PRISM III, e qui-quadrado de 0,48, 8df, p = 0,999, para o PIM 2. Foi obtida área sob a curva Característica de Operação do Receptor de 0,71 para o PRISM III e 0,76 para o PIM 2. Conclusão: Os dois escores superestimaram a mortalidade e demonstraram poder regular de discriminação entre sobreviventes e não sobreviventes. Devem ser desenvolvidos modelos para quantificar a gravidade de pacientes pediátricos com câncer em unidade de terapia intensiva pediátrica e predizer o risco de mortalidade que contemplem suas peculiaridades.
ABSTRACT Objective: To assess the performance of Pediatric Risk of Mortality (PRISM) III and Pediatric Index of Mortality (PIM) 2 scores in the pediatric intensive care unit. Methods: A retrospective cohort study. Data were retrospectively collected from medical records of all patients admitted to the pediatric intensive care unit of a cancer hospital from January 2017 to June 2018. Results: The mean PRISM III score was 15, and PIM 2, 24%. From the 338 studied patients, 62 (18.34%) died. The PRISM III estimated mortality was 79.52 patients (23.52%) and for PIM 2 80.19 patients (23.72%), corresponding to a standardized mortality ratio (95% confidence interval: 0.78 for PRISM II and 0.77 for PIM 2). The Hosmer-Lemeshow chi-square test was 11.56, 8df, 0.975 for PRISM II and 0.48, 8df, p = 0.999 for PIM 2. The area under the Receiver Operating Characteristic curve was 0.71 for PRISM III and 0.76 for PIM 2. Conclusion: Both scores overestimated mortality and have shown a regular ability to discriminate between survivors and non-survivors. Models should be developed to quantify the severity of cancer pediatric patients in Pediatric Intensive Care Units and to predict the mortality risk accounting for their peculiarities.
Subject(s)
Humans , Infant , Child , Critical Illness , Neoplasms , Severity of Illness Index , Intensive Care Units, Pediatric , Prospective Studies , Retrospective Studies , Hospital MortalityABSTRACT
OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.
Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Resuscitation , Shock , Systemic Inflammatory Response Syndrome , COVID-19 , COVID-19 Testing , Clinical Deterioration , Clinical Laboratory Techniques/methods , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Fatal Outcome , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Newborn, Diseases , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Pneumonia, Viral/blood , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Premature Birth , Respiration, Artificial/methods , Resuscitation/methods , Risk Factors , SARS-CoV-2 , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , Tomography, X-Ray Computed/methodsABSTRACT
ABSTRACT Objective: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case description: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. Comments: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.
RESUMO Objetivo: Recentemente, foram descritos relatos de crianças com exame positivo para o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) associado à disfunção de múltiplos órgãos, secundária à hiperinflamação, denominada de síndrome inflamatória multissistêmica pediátrica (do inglês multisystem inflammatory syndrome in children - MIS-C). O objetivo deste relato é descrever um caso de MIS-C em lactente com infecção por SARS-CoV-2 e com evolução fatal abrupta, a despeito do suporte de terapia intensiva pediátrica. Descrição do caso: Lactente de sete meses, com infecção por SARS-CoV-2 e antecedentes de prematuridade extrema, com quadro inicial de síndrome gripal e progressão abrupta para choque vasoplégico, miocardite e síndrome de hiperinflamação, evidenciados por níveis elevados de troponina I, ferritina, proteína C reativa (PCR), dímero D e hipoalbuminemia. Não obstante o suporte de terapia intensiva instituído, a criança evoluiu com disfunção de múltiplos órgãos e morte. Comentários: Pacientes com antecedentes de prematuridade extrema podem apresentar MIS-C na vigência de doença do coronavírus 19 (COVID-19) e constituir um grupo de preocupação especial.