Retrospective Study
Copyright ©The Author(s) 2022.
World J Clin Cases. Oct 16, 2022; 10(29): 10435-10450
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10435
Table 1 World Health Organization case definition for Multisystem inflammatory syndrome in children
All criteria must be met
Age 0 to 19 yr
Fever ≥ 3 d
Clinical signs of multisystem involvement (at least 2 of the following):
Rash, bilateral non purulent conjunctivitis, or mucocutaneous inflammation (oral, hands, or feet)
Hypotension or shock
Cardiac dysfunction, pericarditis, valvulitis, or coronary abnormalities (including echocardiographic findings or elevated troponin/BNP)
Evidence of coagulopathy (prolonged PT or PTT; elevated D-dimer)
Acute gastrointestinal symptoms (diarrhea, vomiting, or abdominal pain)
Elevated markers of inflammation (e.g., ESR, CRP, or procalcitonin)
No other obvious microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes
Evidence of SARS-CoV-2 infection with any of the following:
Positive SARS-CoV-2 RT-PCR
Positive serology
Positive antigen test
Contact with an individual with COVID-19 either laboratory confirmation of SARS-CoV-2 infection by RT-PCR, serology, or antigen test, or known COVID-19 exposure within 4 weeks before symptom onset
Table 2 Demographic data and clinical presentation of the study population
N = 17
Results
Age (yr)23 (2-9)
Weight (kg)217 (12-34)
Gender (male)19 (53)
Ethnicity (white)114 (82)
Comorbidity11 (6)
Known previous COVID-19 disease (4-8 wk before)14 (24)
Contact with known COVID-19 case17 (41)
IgG antibodies to SARS-CoV-2115 (88)
SARS-CoV-2 RT-PCR positive test17 (41)
Fever117 (100)
Days of fever24 (3-4)
Cutaneous rash17 (41)
Conjunctivitis17 (41)
Lymphadenopathy15 (29)
Palmar or plantar erythema13 (17)
Changes in oral mucosa16 (35)
Respiratory symptoms13 (17)
Hypoxemia12 (12)
SpO2 (%)298 (97-99)
Gastrointestinal symptoms110 (58)
Neurological symptoms13 (17)
Heart failure (age-based Ross score > 5)111 (65)
Cardiogenic/Vasoplegic shock13 (17)
Tachycardia113 (76)
Heart rate (bpm)2150 (120-160)
Hypotension14 (23)
Systolic arterial pressure (mmHg)297 (75-106)
Diastolic arterial pressure (mmHg)260 (40-68)
Table 3 Baseline laboratory and echocardiographic data of the study population
N = 17
Results
Leukocytes (/µL)29930 (83490-12250)
Leukocytosis14 (23)
Lymphocytes (/µL)21480 (680-3100)
Lymphopenia19 (53)
Hemoglobin (g/dL)210.7 (8-12.2)
Anemia18 (47)
Thrombocytes (/µL)2161000 (120000-238000)
Thrombocytopenia15 (29)
Dimer D (ng/mL)23504 (3284-5290)
Coagulopathy17 (41)
CRP (mg/L)2171 (121-201)
Procalcitonin (ng/mL)23.2 (1.4-10.2)
Ferritin (ng/mL)2789 (552-978)
Creatinine (mg/dL)20.5 (0.4-0.57)
Urea (mg/dL)223 (19-31)
AKI12 (11)
Sodium (mEq/L)2134 (131-137)
Hyponatremia18 (47)
GPT (U/L)240 (25-66)
Hypertransaminemia16 (35)
pH27.37 (7.34-7.4)
pCO2 (mmHg)237 (33-39)
HCO3 (mmol/L)223 (21-24)
Acidosis14 (23)
NT-proBNP (pg/mL)25221 (2638-10020)
NT-proBNP (Z-log value adjusted for age)24.62 (4.46-5.23)
High NT-proBNP (Z-log for age > 2)117 (100)
Very high NT-proBNP (Z-log for age > 4)112 (71)
hs-TnI (ng/L)235 (10-116)
High hs-TnI (> 50 ng/L)15 (29)
LVEF (%)2
LV dysfunction, n (%)1
Maximal CA diameter (Z-score)2
CA dilation1
Table 4 Treatment and clinical outcomes of the study population
N = 17
Results
IVIG114 (82)
Steroids116 (94)
Aspirin115 (88)
LWH13 (17)
Anakinra13 (17)
Tocilizumab11 (6)
Antibiotics115 (88)
Diuretics110 (53)
Beta blockers16 (35)
ACEIs16 (35)
Antiarrhythmics10 (0)
Oxygen (nasal cannula)12 (11)
CPAP11 (6)
Mechanical ventilation11 (6)
Inotropics17 (41)
ECMO10 (0)
Resistance to immunomodulatory therapy14 (23)
PICU admission17 (41)
PICU stay (days)23.5 (3-4.5)
LOS hospitalization (days)27 (5-10)
Heart failure at discharge11 (6)
Myocardial dysfunction at discharge11 (6)
Coronary artery dilation at discharge12 (11)
Raised hs-TnI or NT-proBNP at discharge19 (53)
Cardiac medications at discharge18 (47)
Any cardiac sequelae or medications at 1 month follow-up10 (0)
Death10 (0)
Table 5 Dynamics of cardiac parameters during the follow-up in this study. Comparison between groups regarding duration of respiratory support
Cardiac parameter
Admission
24 h after AIT
Discharge
After 1-mo fu.
NT-proBNP (Z-log value adjusted for age)24.62 (4.46-5.23)3.78 (3.26-4.87)11.79 (0.66-2.5)10.72 (0.21-1.29)1
Log (10)-Hs-TnI (ng/L)235 (10-116)13 (5-35)110 (10-13)110 (10-10)
LVEF (%)258 (48-65)68 (65-70)170 (66-72)70 (68-71)
Coronary arteries maximal dimension (Z-score for BSA)21.39 (0.56-2.66)1.2 (0.77-1.5)1 (0.5-1.2)10.8 (0.51-1.2)
Age-based Ross classification for heart failure in children28 (4-12)3 (2-7)10 (0-0)10 (0-0)
Table 6 Comparison of clinical, laboratory and echocardiographic characteristics according to the need of pediatric intensive care unit admission and inotropic support during hospitalization
Variable
PICU admission (n = 7; 41%)
No PICU admission (n = 10; 59%)
P value
Age (mo)26 (1-12)2.5 (2-8)NS.
Male sex18 (53)14 (56)NS.
Weight (kg)35 (71)4 (40)NS.
Days of fever24 (2-5)4 (3-4)NS.
Age-based Ross score216 (11-19)4 (2-8)0.003
Lymphocytes (/µL)21240 (720-5940)1552 (1260-3100)NS.
CRP (mg/L)2171 (120-237)167 (131-201)NS.
Procalcitonin (ng/mL)23.6 (1.3-21.6)2.5 (1.4-8.8)NS.
Ferritin (ng/mL)2814 (552-2789)750 (517-878)NS.
Dimer D (ng/mL)23436 (2461-9434)4728 (3284-5290)NS.
NT-proBNP (Z-log for age)25.41 (4.62-6.51)4.48 (4-5)0.016
Troponin I (ng/L)240 (10-909)27 (10-43)NS.
LVEF (%)248 (45-65)62.5 (57-67)0.034
Maximal CA diameter (Z-score)21.2 (0.55-1.4)1.5 (0.5-3)NS.
Table 7 Correlation analysis of the relationship between N-terminal pro-brain natriuretic peptide and all the cardiac continuous variables explored in this study
NT-proBNP (Z-log value adjusted for age)
Correlation coefficient
P value
hs-TnI (ng/L)0.470.045
Age-based Ross score for heart failure0.760.003
LVEF (%)-0.550.021
Maximal CA diameter-0.21NS.