The predictors of severe course of multisystem inflammatory syndrome associated with the new coronavirus infection COVID-19 in children: results of a retrospective-prospective multicenter study
- Authors: Avrusin I.S.1, Abramova N.N.1, Belozerov K.E.1, Efremova O.S.2,3, Bregel L.V.2,3, Kondratiev G.V.1, Dondurey E.A.4,5, Vilnitz A.A.1,6, Konstantinova Y.E.6, Burtseva T.E.7,8, Vinnikova E.I.1, Isupova E.A.1, Kornishina T.L.1, Masalova V.V.1, Redkina M.V.1, Solodkova I.V.1, Kalashnikova O.V.1, Chasnyk V.G.1, Alexandrovich Y.S.1, Kostik M.M.1
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Affiliations:
- St. Petersburg State Pediatric Medical University
- Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional Education
- Irkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research Center
- A.A. Smorodintsev Influenza Research Institute
- N.F. Filatov Children’s City Clinical Hospital No. 5
- Children’s Scientific and Clinical Center of Infectious Diseases
- North-Eastern Federal University
- Yakut Science Centre of Complex Medical Problems
- Issue: Vol 14, No 1 (2023)
- Pages: 45-59
- Section: Original studies
- URL: https://journals.rcsi.science/pediatr/article/view/131597
- DOI: https://doi.org/10.17816/PED14145-59
- ID: 131597
Cite item
Abstract
BACKGROUND: Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases.
AIM: To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit.
MATERIALS AND METHODS: The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of “multisystem inflammatory syndrome associated with COVID-19 in children”. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 — patients hospitalized in the intensive care unit (n = 84, 50.6%), and group 2 — patients who did not need hospitalization in the intensive care unit (n = 82, 49.4%).
RESULTS: Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed.
CONCLUSIONS: The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.
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##article.viewOnOriginalSite##About the authors
Ilia S. Avrusin
St. Petersburg State Pediatric Medical University
Email: avrusin95@gmail.com
senior research assistant, assistant professor of the Department of Hospital Pediatrics, assistant professor of the Department of General Medical Practice
Russian Federation, Saint PetersburgNatalia N. Abramova
St. Petersburg State Pediatric Medical University
Email: abrnatalia@yandex.ru
doctor of the Intensive Care Unit
Russian Federation, Saint PetersburgKonstantin E. Belozerov
St. Petersburg State Pediatric Medical University
Email: biancolago@bk.ru
postgraduate student, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgOlesya S. Efremova
Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research Center
Email: shaguno@mail.ru
cardiologist, assistant of the Department of Pediatrics
Russian Federation, Irkutsk; IrkutskLyudmila V. Bregel
Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research Center
Email: loudmilabregel@yandex.ru
chief pediatric cardiologist of the Irkutsk Region, MD, PhD, Dr. Sci. (Med.), professor, head of the Department of Pediatrics, head, Department of Cardiology
Russian Federation, Irkutsk; IrkutskGleb V. Kondratiev
St. Petersburg State Pediatric Medical University
Email: spbgvk@mail.ru
pediatric oncologist, assistant professor of the Department of Oncology, Pediatric Oncology and Radiation Therapy
Russian Federation, Saint PetersburgElena A. Dondurey
A.A. Smorodintsev Influenza Research Institute; N.F. Filatov Children’s City Clinical Hospital No. 5
Email: dondureyelena@yandex.ru
chief pediatric infectious disease specialist of Saint Petersburg, MD, PhD, head, Infectious Boxed Department. ; senior lecturer
Russian Federation, Saint Petersburg; Saint PetersburgAlla A. Vilnitz
St. Petersburg State Pediatric Medical University; Children’s Scientific and Clinical Center of Infectious Diseases
Email: vilnitz@mail.ru
MD, PhD, Dr. Sci. (Med.), head, Research Department of Intensive Care of Emergency Conditions; professor, Department of Infectious Diseases in Children of AF and DPO
Russian Federation, Saint Petersburg; Saint PetersburgYulia E. Konstantinova
Children’s Scientific and Clinical Center of Infectious Diseases
Email: yulia.konstantinova23@mail.ru
junior research associate
Russian Federation, Saint PetersburgTatiana E. Burtseva
North-Eastern Federal University; Yakut Science Centre of Complex Medical Problems
Email: bourtsevat@yandex.ru
MD, PhD, Dr. Sci. (Med.), professor, Department of Pediatrics and Pediatric Surgery; head of the laboratory
Russian Federation, Yakutsk; YakutskEkaterina I. Vinnikova
St. Petersburg State Pediatric Medical University
Email: katya.vinni99@gmail.com
студентка 6-го курса педиатрического факультета
Russian Federation, Saint PetersburgEvgeniya A. Isupova
St. Petersburg State Pediatric Medical University
Email: miaposta@list.ru
MD, PhD, rheumatologist
Russian Federation, Saint PetersburgTatiana L. Kornishina
St. Petersburg State Pediatric Medical University
Email: tk.06@mail.ru
assistant professor, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgVera V. Masalova
St. Petersburg State Pediatric Medical University
Email: masalova.vera@gmail.com
assistant professor, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgMaria V. Redkina
St. Petersburg State Pediatric Medical University
Email: redkina_masha@mail.ru
pediatrician, head, consultative and diagnostic center
Russian Federation, Saint PetersburgIrina V. Solodkova
St. Petersburg State Pediatric Medical University
Email: isolodkova@mail.ru
MD, PhD, associate professor, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgOlga V. Kalashnikova
St. Petersburg State Pediatric Medical University
Email: koira7@yandex.ru
MD, PhD, head, Pediatric Department No. 3, assistant professor, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgVyacheslav G. Chasnyk
St. Petersburg State Pediatric Medical University
Email: chasnyk@gmail.com
MD, PhD, Dr. Sci. (Med.), professor, head, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgYuri S. Alexandrovich
St. Petersburg State Pediatric Medical University
Email: jalex1963@mail.ru
MD, PhD, Dr. Sci. (Med.), professor, head, Department of Anesthesiology, Resuscitation and Emergency Pediatrics of FP and DPO, vice-rector for postgraduate and additional professional education
Russian Federation, Saint PetersburgMikhail M. Kostik
St. Petersburg State Pediatric Medical University
Author for correspondence.
Email: kost-mikhail@yandex.ru
MD, PhD, Dr. Sci. (Med.), chief pediatric specialist rheumatologist, North-Eastern Federal District; Professor, Department of Hospital Pediatrics
Russian Federation, Saint PetersburgReferences
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