Distinguishing Features of Patients Evaluated for Multisystem Inflammatory Syndrome in Children
Distinguishing Features of Patients Evaluated for Multisystem Inflammatory Syndrome in Children
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DOI：
10.1097/pec.0000000000002344
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发表时间：
2021-03-01
影响因子：
1.4
通讯作者：
Chiu, Joanne S.
中科院分区：
文献类型：
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作者：
Kelly, Michael S.;Fernandes, Neil D.;Chiu, Joanne S.
目的鉴于儿童多系统炎症综合征(MIS-C)与急诊科常见的其他儿童疾病有显著重叠，因此有必要对该综合征进行广泛的研究。然而，很少有关于急性护理环境中的MIS-C区别于其他条件的因素的发表。我们调查了疑似和确诊的MIS-C患者在临床表现和实验室研究方面的差异。方法这是一项回顾性队列研究，研究对象为在2020年4月21日至7月1日期间在单一机构接受可能的MI-C调查的21岁或以下的患者。主要结果是被诊断为MIS-C或另一种最终诊断。临床特征和实验室结果从最初的表现收集和分析。结果共纳入106例患者(中位数4岁，男性占55.7%)，其中17例(16%)符合临床诊断标准。儿童多系统炎症综合征患者报告2019年接触冠状病毒的可能性显著更高(OR，13.17[3.87-44.9])，有胃肠道症状(OR，3.81[1.02-14.19])，并有显著更高的实验室指标异常，包括高敏肌钙蛋白T(OR，13[4.0-42.2])、N末端B型利钠肽(OR，8.4[2.3-30.1])、D-二聚体(OR，13[1.6-103])、和铁蛋白(OR，7.8[2.2-27.2])。炎症标志物：C反应蛋白(中位数，134.45 mg/L vs12.6 mg/L；P<；0.001)和降钙素原(1.71 ng/mLvs0.14 ng/mL；P<；0.001)。结论在关键实验室研究中，较高的海拔高度可能有助于区分到急诊科就诊的MI-C患者和非MI-C患者。
ObjectivesGiven the significant overlap of multisystem inflammatory syndrome in children (MIS-C) with other common childhood illnesses presenting to the emergency department, extensive workup of this syndrome has become necessary. Nevertheless, little has been published on the factors differentiating MIS-C from other conditions in the acute care setting. We investigated differences in presentation and laboratory studies between suspected versus confirmed MIS-C patients. MethodsThis was a retrospective cohort study on patients 21 years or younger undergoing investigation for possible MIS-C at a single institution between April 21 and July 1, 2020. The primary outcome was diagnosis of MIS-C or an alternative final diagnosis. Clinical features and laboratory findings from initial presentation were collected and analyzed. ResultsA total of 106 patients (median, 4 years; 55.7% male) were included, of whom 17 (16%) of 106 met the criteria for MIS-C. Multisystem inflammatory syndrome in children patients were significantly more likely to report a coronavirus disease 2019 exposure (odds ratio (OR), 13.17 [3.87-44.9]), have gastrointestinal symptoms (OR, 3.81 [1.02-14.19]), and have a significantly higher odds of having abnormal laboratory values including high-sensitivity troponin T (OR, 13 [4.0-42.2]), N-terminal B-type natriuretic peptide (OR, 8.4 [2.3-30.1]), D-dimer (OR, 13 [1.6-103]), and ferritin (OR, 7.8 [2.2-27.2]). There were also differences between groups in inflammatory markers: C-reactive protein (median, 134.45 mg/L vs 12.6 mg/L; P < 0.05) and procalcitonin (1.71 ng/mL vs 0.14 ng/mL; P < 0.001). ConclusionsHigher elevations in key laboratory studies may help to distinguish between MIS-C patients and non-MIS-C patients presenting to the emergency department.