Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

Authors

  • Maria Fernanda Badue Pereira Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente https://orcid.org/0000-0001-8844-8245
  • Nadia Litvinov Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Sylvia Costa Lima Farhat Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Sylvia Costa Lima Farhat Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Adriana Pasmanik Eisencraft Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Maria Augusta Bento Cicaroni Gibelli Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente https://orcid.org/0000-0001-9074-7500
  • Werther Brunow de Carvalho Universidade de Sao Paulo, Faculdade de Medicina https://orcid.org/0000-0002-9164-616X
  • Vinicius Rodrigues Fernandes Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Thais de Toledo Fink Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Juliana Vale´ria de Souza Framil Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Karine Vusberg Galleti Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas
  • Alice Lima Fante Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas
  • Maria Fernanda Mota Fonseca Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinica, Instituto de Tratamento do Cancer Infantil
  • Andreia Watanabe Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Camila Sanson Yoshino de Paula Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Giovanna Gavros Palandri Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Gabriela Nunes Leal Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • Maria de Fatima Rodrigues Diniz Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente
  • João Renato Rebello Pinho Universidade de Sao Paulo, Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Laboratorio de Biologia Molecular
  • Clovis Artur Silva Universidade de Sao Paulo, Faculdade Medicina https://orcid.org/0000-0001-9250-6508
  • Heloisa Helena de Sousa Marques Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto da Crianca e do Adolescente https://orcid.org/0000-0002-1340-0463
  • Pediatric COVID HC-FMUSP Study Group Pediatric COVID HC-FMUSP Study Group

DOI:

https://doi.org/10.6061/clinics/2020/e2209

Abstract

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (ageo18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels 450 mg/L (83% vs. 25%, p=0.008) and D-dimer levels 41000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (po0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, po0.001), vasoactive agent use (83% vs. 3%, po0.001), shock (83% vs. 5%, po0.001), cardiac abnormalities (100% vs. 2%, po0.001), and death (67% vs. 3%, po0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, po0.001), aspirin therapy (50% vs. 0%, po0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39- 526.79; po0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.

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Published

2020-08-29

How to Cite

Pereira, M. F. B., Litvinov, N., Farhat, S. C. L., Farhat, S. C. L., Eisencraft, A. P., Gibelli, M. A. B. C., Carvalho, W. B. de, Fernandes, V. R., Fink, T. de T., Framil, J. V. de S., Galleti, K. V., Fante, A. L., Fonseca, M. F. M., Watanabe, A., Paula, C. S. Y. de, Palandri, G. G., Leal, G. N., Diniz, M. de F. R., Pinho, J. R. R., Silva, C. A., Marques, H. H. de S., & Study Group, P. C. H.-F. (2020). Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics, 75, e2209. https://doi.org/10.6061/clinics/2020/e2209

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Section

Original Articles