Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study.
Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study.
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DOI：
10.1016/s2352-4642(21)00050-x
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发表时间：
2021-05
期刊：
影响因子：
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通讯作者：
Belay ED
中科院分区：
文献类型：
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作者：
Abrams JY;Oster ME;Godfred-Cato SE;Bryant B;Datta SD;Campbell AP;Leung JW;Tsang CA;Pierce TJ;Kennedy JL;Hammett TA;Belay ED
儿童多系统炎症综合征是一种新发现的与SARS-CoV-2感染相关的严重健康问题。不同患者的临床表现差异很大，这项研究的目的是调查与严重预后相关的因素。在这项回顾性监测研究中，符合美国疾病控制和预防中心MISC病例定义的患者(21岁以下，发烧，实验室炎症证据，住院，多系统[≥2]器官受累[心脏，肾脏，呼吸系统，血液，胃肠，皮肤科或神经系统]，没有其他可信的诊断，或者通过RT-PCR法、血清学或抗原测试实验室确认感染SARS-CoV2，或在症状出现前4周内已知接触新冠肺炎)，由州和地方卫生部门使用标准病例报告表格向CDC报告。评估与严重后果潜在联系的因素包括先前存在的患者因素(性别、年龄、种族或民族、肥胖和2020年6月1日之前的MI-C症状出现日期)和临床结果(体征或症状和实验室标记物)。在对所有先前存在的因素进行调整后，Logistic回归模型被用来估计潜在的解释因素与以下结果之间的优势比：重症监护病房(ICU)入院、休克、心功能下降、心肌炎和冠状动脉异常。1080名患者符合疾控中心对MIS-C的病例定义，并在2020年3月11日至10月10日之间出现症状。与0-5岁的患者相比，6-12岁的患者(调整后的优势比1·9[95%CI 1·4-2·6)和13-20岁的患者(2·6[1·8-3·8])更有可能进入ICU，与非西班牙裔白人患者(1·6[1·0-2·4])相比，非西班牙裔黑人患者更有可能进入ICU。呼吸急促(1·9[1·2~2·9])、腹痛(1·7[1·2~2·7])、C-反应蛋白、肌钙蛋白、铁蛋白、D-二聚体、脑利钠肽(BNP)、N-末端B型BNP原或白细胞介素6(IL-6)浓度升高或血小板或淋巴细胞数量减少的患者更有可能进入ICU。我们发现心功能下降、休克和心肌炎也有类似的相关性。男性患者冠状动脉病变(1·5[1·1~2·1])多于女性患者和皮肤黏膜病变(2·2[1·3~3·5])或结膜注射患者(2·3[1·4~3·7])。确定重要的人口学和临床特征有助于早期识别和迅速处理严重后果的患者。没有。
Multisystem inflammatory syndrome in children (MIS-C) is a newly identified and serious health condition associated with SARS-CoV-2 infection. Clinical manifestations vary widely among patients with MIS-C, and the aim of this study was to investigate factors associated with severe outcomes. In this retrospective surveillance study, patients who met the US Centers for Disease Control and Prevention (CDC) case definition for MIS-C (younger than 21 years, fever, laboratory evidence of inflammation, admitted to hospital, multisystem [≥2] organ involvement [cardiac, renal, respiratory, haematological, gastrointestinal, dermatological, or neurological], no alternative plausible diagnosis, and 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) were reported from state and local health departments to the CDC using standard case-report forms. Factors assessed for potential links to severe outcomes included pre-existing patient factors (sex, age, race or ethnicity, obesity, and MIS-C symptom onset date before June 1, 2020) and clinical findings (signs or symptoms and laboratory markers). Logistic regression models, adjusted for all pre-existing factors, were used to estimate odds ratios between potential explanatory factors and the following outcomes: intensive care unit (ICU) admission, shock, decreased cardiac function, myocarditis, and coronary artery abnormalities. 1080 patients met the CDC case definition for MIS-C and had symptom onset between March 11 and Oct 10, 2020. ICU admission was more likely in patients aged 6–12 years (adjusted odds ratio 1·9 [95% CI 1·4–2·6) and patients aged 13–20 years (2·6 [1·8–3·8]), compared with patients aged 0–5 years, and more likely in non-Hispanic Black patients, compared with non-Hispanic White patients (1·6 [1·0–2·4]). ICU admission was more likely for patients with shortness of breath (1·9 [1·2–2·9]), abdominal pain (1·7 [1·2–2·7]), and patients with increased concentrations of C-reactive protein, troponin, ferritin, D-dimer, brain natriuretic peptide (BNP), N-terminal pro B-type BNP, or interleukin-6, or reduced platelet or lymphocyte counts. We found similar associations for decreased cardiac function, shock, and myocarditis. Coronary artery abnormalities were more common in male patients (1·5 [1·1–2·1]) than in female patients and patients with mucocutaneous lesions (2·2 [1·3–3·5]) or conjunctival injection (2·3 [1·4–3·7]). Identification of important demographic and clinical characteristics could aid in early recognition and prompt management of severe outcomes for patients with MIS-C. None.