scholarly journals Strain Echocardiography and Myocardial Dysfunction in Critically Ill Children With Multisystem Inflammatory Syndrome Unrecognized by Conventional Echocardiography

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sonali Basu ◽  
Esther J. Kim ◽  
Matthew P. Sharron ◽  
Ashley Austin ◽  
Murray M. Pollack ◽  
...  
Keyword(s):  
Critically Ill ◽  
Myocardial Dysfunction ◽  
Critically Ill Children ◽  
Inflammatory Syndrome ◽  
Conventional Echocardiography ◽  
Strain Echocardiography

scholarly journals Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lorena Acevedo ◽  
Byron Enrique Piñeres-Olave ◽  
Laura Fernanda Niño-Serna ◽  
Liliana Mazzillo Vega ◽  
Ivan Jose Ardila Gomez ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Clinical Characteristics ◽  
Myocardial Dysfunction ◽  
High Income ◽  
World Health ◽  
Critically Ill Children ◽  
Middle Income ◽  
Coronary Aneurysms ◽  
Inflammatory Syndrome

Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

scholarly journals Mortality and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in critically ill patients: an observational multicenter study (MISCO STUDY)

2021 ◽  
Author(s):  
Lorena Acevedo ◽  
Byron Enrique Piñeres-Olave ◽  
Laura Fernanda Niño-Serna ◽  
Liliana Mazillo-Vega ◽  
Ivan Jose Ardila Gómez ◽  
...  
Keyword(s):  
Critically Ill ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Myocardial Dysfunction ◽  
Cardiovascular Complications ◽  
High Income ◽  
Critically Ill Children ◽  
Middle Income ◽  
One Year ◽  
Inflammatory Syndrome

Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 is widespread and presents a very low mortality rate in highincome countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries compared to described series in high-income countries along with the factors associated with mortality and worse outcomes. Methods An observational cohort study was conducted in 14 PICUs in Colombia between April 01, 2020 and January 31, 2021. Patient´s age ranged between one month and 18 years and they met the requirements set forth by WHO for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1- 11), 18% (14/78) were under one year old, and 56% were male. Thirty-five percent (29/78) were obese or overweight. The PICU stay was six days (IQR 4-7), and 100% had a fever on admission lasting five days (IQR 3.7-6). Seventy percent (55/78) had diarrhea, and 87% (68/78) had shock or myocardial dysfunction (78%). Compared to the United Kingdom (UK) study, there were more children under the age of five (37% vs. 10%; p=0.004), and there was a higher frequency of obesity (29.5% vs. 10%; p=0.008). With regard to the US study, there was more lymphadenopathy (23% vs. 13%; p=0.02), diarrhea (70.5% vs. 53%; p=0.001), lymphopenia (64% vs. 35%; p=0.001), shock (87% vs. 35%; p=0.001), elevated troponin (51% vs. 31%; p=0.006) and elevated proBNP (82% vs 43%; p=0.001), as well as greater mortality (9% vs 1.8%; p=0.001). The group that did not survive had a longer duration of the disease until admission to the PICU (6 days vs. 5 days; p = 0.003), more frequency of ferritin above 500 ngr/mL (100% vs. 45%; p = 0.012) and more cardiovascular complications (100% vs. 54%; p = 0.019) compared to the group that survived. Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. It was observed inflammatory response, and cardiovascular involvement were conditions that, added to the difficulties in accessing healthcare systems in countries with limited resources, may explain the higher mortality seen in these children.

scholarly journals 542. SARS CoV-2-Associated Multisystem Inflammatory Syndrome of Children (MIS-C) in the Washington DC Metropolitan Region

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S338-S338
Author(s):  
Roberta L DeBiasi ◽  
Karen L Smith ◽  
Michael Bell ◽  
Charles Berul ◽  
Emily Ansusinha ◽  
...  
Keyword(s):  
Critically Ill ◽  
Medical Condition ◽  
Myocardial Dysfunction ◽  
Demographic Data ◽  
Response To Therapy ◽  
Metropolitan Region ◽  
Critically Ill Children ◽  
Washington Dc ◽  
Long Term Outcome ◽  
Inflammatory Syndrome

Abstract Background Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population. Methods This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children’s National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized. Results Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7–18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33; 15%), coronary ectasia (4/33; 12%), coronary aneurysm (3/33; 9%), or pericardial effusion 5/33; 15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred. Conclusion The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority. Disclosures Andrea Hahn, MD, MS, Johnson and Johnson (Consultant)

Thromboelastography profiles in critically ill children with multisystem inflammatory syndrome

2021 ◽  
Author(s):  
Kavita Morparia ◽  
Philip C. Spinella ◽  
Derrick McQueen ◽  
Meena Kalyanaraman ◽  
Maria Bergel ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Children ◽  
Inflammatory Syndrome

scholarly journals Abdominal Imaging Findings in Critically Ill Children With Multisystem Inflammatory Syndrome Associated With COVID-19

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kavita Morparia ◽  
Min Jung Park ◽  
Meena Kalyanaraman ◽  
Derrick McQueen ◽  
Maria Bergel ◽  
...  
Keyword(s):  
Critically Ill ◽  
Abdominal Imaging ◽  
Critically Ill Children ◽  
Imaging Findings ◽  
Inflammatory Syndrome

scholarly journals Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series

2020 ◽  
Vol 9 (3) ◽  
pp. 393-398 ◽  
Author(s):  
Kathleen Chiotos ◽  
Hamid Bassiri ◽  
Edward M Behrens ◽  
Allison M Blatz ◽  
Joyce Chang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Mucous Membrane ◽  
Case Series ◽  
Critically Ill Children ◽  
Membrane Changes ◽  
Inflammatory Syndrome

Abstract We present a series of 6 critically ill children with multisystem inflammatory syndrome in children. Key findings of this syndrome include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.

scholarly journals AB0739 MULTISYSTEM INFLAMMATORY SYNDROME ASSOCIATED WITH SARS-COV-2 INFECTION AND E.COLI SEPSIS: THE POTENTIAL ROLE OF PROCALCITONINE AS A RAPID DIAGNOSTIC BIOMARKER TO DISTINGUISH TWO DIFFERENT PHASES OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1399.1-1399
Author(s):  
M. Gilio ◽  
S. B. Morella ◽  
F. Picaro ◽  
C. Acierno ◽  
D. Palazzo ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Systemic Inflammatory Response ◽  
Critically Ill Children ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Inflammatory Syndrome

Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology.Objectives:We report a case of multisystem inflammatory syndrome in children (MIS-C) in patient with SARS-CoV-2 infection and Enteropathogenic Escherichia coli (EPEC) sepsis due to acute enteritis, observed at end of December 2020 to a tertiary-care center (San Carlo Hospital), in Basilicata region (Italy).Methods:This healthy 12-year- old male patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Clinical presentations was characterized by fever, abdominal pain, gastrointestinal complaints and evanescent rash. Laboratory values were remarkable for high levels of procalcitonin, C-reactive protein (CRP), D-dimers, B-type natriuretic peptide (BNP), and troponin. He also had low albumin levels. Autoantibodies tests were negative. Chest tomography showed ground-glass opacities in less than 25% of the lungs, small bilateral pleural effusion and increased cardiac area; abdominal tomography showed enlargement of the lymphnodes and ascites. Evaluation for other infectious etiologies showed molecular test positivity on fecal samples for EPEC E. coli. He received broad spectrum intravenous antibiotics (macrolids and quinolones and then carbapenems). On the seventh day the enteritis resolved and procalcitonin normalized, however he continued to have lymphopenia, thrombocytopenia, hypoalbuminemia, elevated levels of CRP, D-dimers, ferritin, troponin, and increased BNP. On the ninth day he was feverish again and developed severe cardiac and respiratory failure requiring advanced respiratory support and admission to the intensive care unit. He received IVIG (intravenous immunoglobulin at 2 g/Kg, glucocorticoids (Methylprednisolone 1mg/kg) and enoxaparin.Results:The patient was discharged asymptomatic at home after 28 days of hospital stay.Conclusion:We observed multisystem inflammatory syndrome in children (MIS-C) in a previously healthy patient with SARS-CoV-2 infection and E.coli sepsis, who became critically ill with multisystem involvement. In this case viral and bacterial infections could be considered as a double hit for the etiopathogenesis of MIS-C. The trend of procalcitonin was better than C-reactive protein for differentiating bacterial from non-bacterial phase of systemic inflammatory response syndrome (SIRS) in this critically ill child. Although the accuracy of both tests is moderate. Diagnostic accuracy could be enhanced by combining these tests with bedside clinical judgment.References:[1]Consiglio CR, Cotugno N, Sardh et al. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell. 2020 Nov 12;183(4):968-981.e7. doi: 10.1016/j.cell.2020.09.016. Epub 2020 Sep 6. PMID: 32966765; PMCID: PMC7474869.[2]Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel). 2020 Jul 1;7(7):69. doi: 10.3390/children7070069. PMID: 32630212; PMCID: PMC7401880.[3]Simon L, Saint-Louis P, Amre DK, Lacroix J, Gauvin F. Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome. Pediatr Crit Care Med. 2008 Jul;9(4):407-13. PMID: 18496408.Disclosure of Interests:None declared

scholarly journals Case Report: Endothelial Glycocalyx Damage in Critically ill Patients With SARS-CoV-2-Related Multisystem Inflammatory Syndrome (MIS-C)

2021 ◽  
Vol 9 ◽  
Author(s):  
Jaime Fernández-Sarmiento ◽  
Steffanie Flórez ◽  
Laura C. Alarcón-Forero ◽  
Lina María Salazar-Peláez ◽  
Julio Garcia-Casallas ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Virus Disease ◽  
Clinical Manifestations ◽  
Endothelial Activation ◽  
Endothelial Glycocalyx ◽  
Imaging Biomarkers ◽  
Critically Ill Children ◽  
Inflammatory Syndrome

Endothelial insult and damage is one of the reported consequences of SARS-CoV-2 infection. It has been associated with severe inflammation, thrombotic phenomena and profound hypoxemia in critically ill patients. Endothelial activation leads to a loss of the endothelium's antithrombotic properties which, under normal conditions, are maintained by the endothelial glycocalyx, a carbohydrate-rich layer that covers the luminal surface of endothelial cells. In children, one of the serious forms of SARS-CoV-2 virus disease (COVID-19) is multisystem inflammatory syndrome (MIS-C). This new disease is characterized by a large inflammatory response and frequent cardiovascular, cutaneous and gastrointestinal disorders. We describe the first two cases of critically ill children with MIS-C who evidenced a large inflammatory response associated with elevated plasma and imaging biomarkers of endothelial activation and endothelial glycocalyx degradation. This microcirculation involvement in MIS-C could, at least partially, explain some of the clinical manifestations and laboratory and imaging alterations found in these patients. These findings contribute to a better understanding of this disease and suggest that medications to modulate the inflammatory response and protect or restore the endothelial glycocalyx should be considered in future studies.

scholarly journals The Role of Lactate and Other Laboratory Markers on Detection of Subtle Myocardial Dysfunction in Critically ill Children

2021 ◽  
Vol 9 (T3) ◽  
pp. 265-269
Author(s):  
Munar Lubis ◽  
Aridamuriany Dwiputri Lubis ◽  
Badai Buana Nasution
Keyword(s):  
Critically Ill ◽  
Troponin I ◽  
Complete Blood Count ◽  
Myocardial Dysfunction ◽  
Gas Analysis ◽  
Critically Ill Children ◽  
Significant Finding ◽  
Early Assessment ◽  
Laboratory Markers

BACKGROUND: Critically ill patients have a high risk of developing life-threatening infections that can eventually lead to multi-organ failure. The cardiovascular system involvement could increase the mortality rate by 70-90%. Myocardial dysfunction is often accompanied by a state of metabolic acidosis, liver damage, kidney damage, and anemia. Therefore laboratory markers and elevated lactate levels may aid in the early assessment of a myocardial dysfunction AIM: The aim of this study was to prove the role of lactate and other laboratory markers on detection of subtle myocardial dysfunction (SMD) in critically ill children admitted to the Pediatric Intensive Care Unit (PICU). METHODS: An observasional cohort study in PICU Haji Adam Malik General Hospital, Medan. Assessment of complete blood count, kidney function, liver function, lactic acid, blood gas analysis, and troponin I within 48 hoursPICU admission. The results of the troponin value was said to be subtle myocardial dysfunction if the troponin I value is ≥ 0.4 ng/ml RESULT: 55 subjects were recruited in this study, 23 subject (41.1%) with SMD. Laboratory marker in SMD that has significant finding were lactate, AST, ALT, Hemoglobin (p = 0.003; p = 0.028; p = 0.01; p = 0.001, repectively). High lactate ( > 2.5 ng/ml) could be used as a predictor for SMD with sensitivity 74% and specificity 72%. Subject with SMD has significant association with mortality (p <0.001). CONCLUSION: Subtle myocardial dysfunction should be suspected in patient with blood lactate level > 2.5 ng/ml, with significant association between SMD and mortality.

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