Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital
Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital
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DOI：
10.1007/s00246-020-02391-2
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发表时间：
2020-06-12
影响因子：
1.6
通讯作者：
Chikermane, Ashish
中科院分区：
文献类型：
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作者：
Ramcharan, Tristan;Nolan, Oscar;Chikermane, Ashish
在COVID-19疫情期间，儿童相对幸免。然而，最近报道的具有川崎和中毒性休克综合征的重叠特征的高炎症综合征-“与SARS-CoV-2暂时相关的儿科炎症性多系统综合征”（PIMS-TS）引起了关注。我们描述了三级儿童医院PIMS-TS患儿的心脏表现和短期预后。2020年4月10日至5月9日在PIMS-TS儿童中进行的单中心观察性研究。回顾性分析ECG和超声心动图数据沿着人口统计学、临床特征和血液参数。纳入了15名中位年龄为8.8岁（IQR 6.4-11.2）的儿童，均来自非洲/非洲-加勒比、南亚、混血或其他少数族裔群体。所有患者均显示炎症/心脏标志物（CRP、铁蛋白、肌钙蛋白I、CK和pro-BNP）升高。10例患者（67%）出现一过性瓣膜返流。12例（80%）左室射血分数降低，8例（53%）缩短分数降低，除2例外，其余均消退。14例（93%）有冠状动脉异常，6例正常化。9例（60%）患者出现ECG异常，6例出院时恢复正常。10例（67%）需要正性肌力药物和/或血管加压药。没有人需要体外生命支持。心脏生化标志物的改善紧随ECG/超声心动图的改善。所有患者均存活出院，此后对12例（80%）患者进行了审查。我们的整个PIMS-TS队列都有心脏受累，这种受累程度明显高于其他已发表的系列，并强调需要进行专家心脏检查。我们相信，我们的多学科团队方法对于良好的短期结果至关重要。
Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.