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

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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.

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 Petersburg

Natalia N. Abramova

St. Petersburg State Pediatric Medical University

Email: abrnatalia@yandex.ru

doctor of the Intensive Care Unit

Russian Federation, Saint Petersburg

Konstantin E. Belozerov

St. Petersburg State Pediatric Medical University

Email: biancolago@bk.ru

postgraduate student, Department of Hospital Pediatrics

Russian Federation, Saint Petersburg

Olesya 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; Irkutsk

Lyudmila 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; Irkutsk

Gleb 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 Petersburg

Elena 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 Petersburg

Alla 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 Petersburg

Yulia E. Konstantinova

Children’s Scientific and Clinical Center of Infectious Diseases

Email: yulia.konstantinova23@mail.ru

junior research associate

Russian Federation, Saint Petersburg

Tatiana 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; Yakutsk

Ekaterina I. Vinnikova

St. Petersburg State Pediatric Medical University

Email: katya.vinni99@gmail.com

студентка 6-го курса педиатрического факультета

Russian Federation, Saint Petersburg

Evgeniya A. Isupova

St. Petersburg State Pediatric Medical University

Email: miaposta@list.ru

MD, PhD, rheumatologist

Russian Federation, Saint Petersburg

Tatiana L. Kornishina

St. Petersburg State Pediatric Medical University

Email: tk.06@mail.ru

assistant professor, Department of Hospital Pediatrics

Russian Federation, Saint Petersburg

Vera V. Masalova

St. Petersburg State Pediatric Medical University

Email: masalova.vera@gmail.com

assistant professor, Department of Hospital Pediatrics

Russian Federation, Saint Petersburg

Maria V. Redkina

St. Petersburg State Pediatric Medical University

Email: redkina_masha@mail.ru

pediatrician, head, consultative and diagnostic center

Russian Federation, Saint Petersburg

Irina V. Solodkova

St. Petersburg State Pediatric Medical University

Email: isolodkova@mail.ru

MD, PhD, associate professor, Department of Hospital Pediatrics

Russian Federation, Saint Petersburg

Olga 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 Petersburg

Vyacheslav 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 Petersburg

Yuri 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 Petersburg

Mikhail 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 Petersburg

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