Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2
Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2
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DOI：
10.1001/jama.2020.10369
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发表时间：
2020-07-21
影响因子：
120.7
通讯作者：
Levin, Michael
中科院分区：
文献类型：
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作者：
Whittaker, Elizabeth;Bamford, Alasdair;Levin, Michael
重要性在2019年冠状病毒病发病率高的社区，描述符合与严重急性呼吸综合征冠状病毒2型暂时相关的小儿炎性多系统综合征标准的住院儿童的临床和实验室特征（SARS-CoV-2）（PIMS-TS）并将这些特征与其他儿科炎症性疾病进行比较。设计、设置和参与者病例系列来自2020年3月23日至5月16日期间在英格兰8家医院住院的58名儿童，持续发热和炎症的实验室证据符合PIMS-TS的公开定义。最终随访日期为2020年5月22日。通过回顾性病历分析，提取临床和实验室特征，并与川崎（KD）患者的临床特征进行比较KD休克综合征45例，中毒性休克综合征（n = 37）2002年至2019年期间在欧洲和美国的医院住院的儿童。主要结果和指标符合PIMS-TS定义标准的儿童的临床、实验室和影像学特征，并与其他儿科炎症性疾病的特征进行比较。（中位年龄，9岁[四分位距{IQR}，5.7-14]; 20名女孩[34%]）被确定为符合PIMS-TS标准。58例患者中有15例（26%）SARS-CoV-2聚合酶链反应检测结果呈阳性，46例患者中有40例（87%）SARS-CoV-2 IgG检测结果呈阳性。总共有45/58例患者（78%）有当前或既往SARS-CoV-2感染的证据。所有患儿均出现发热和非特异性症状，包括呕吐（26/58 [45%]）、腹痛（31/58 [53%]）和腹泻（30/58 [52%]）。皮疹30/58例（52%），结膜充血26/58例（45%）。实验室评价与明显炎症一致，例如C反应蛋白（229 mg/L [IQR，156-338]，在58/58中评估）和铁蛋白（610 μ g/L [IQR，359-1280]，在53/58中评估）。在58名儿童中，29名发生休克（有心肌功能障碍的生化证据），需要强心剂支持和液体复苏（包括接受机械通气的23/29 [79%]）; 13名符合美国心脏协会对KD的定义，23名有发热和炎症，但无休克或KD的特征。8例患者（14%）发生冠状动脉扩张或动脉瘤。PIMS-TS与KD和KD休克综合征的比较显示了临床和实验室特征的差异，包括年龄较大（中位年龄分别为9岁[IQR，5.7-14] vs 2.7岁[IQR，1.4-4.7]和3.8岁[IQR，0.2-18]），以及炎症标志物（如C反应蛋白）更高（中位数分别为229 mg/L [IQR 156-338] vs 67 mg/L [IQR，40- 150 mg/L]和193 mg/L [IQR，83-237]）。结论和相关性在符合PIMS-TS标准的住院儿童的该病例系列中，存在广泛的表现体征和症状以及疾病严重程度，从发烧和炎症到心肌损伤、休克和冠状动脉瘤的发展。与KD和KD休克综合征患者的比较提供了对这种综合征的见解，并表明这种疾病不同于其他儿科炎症实体。
IMPORTANCE In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation.OBJECTIVES To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders.DESIGN, SETTING, AND PARTICIPANTS Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019.EXPOSURES Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization.MAIN OUTCOMES AND MEASURES Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders.RESULTS Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 mu g/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229mg/L [IQR 156-338] vs 67mg/L [IQR, 40-150mg/L] and 193mg/L [IQR, 83-237], respectively).CONCLUSIONS AND RELEVANCE In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.