Acute Hepatitis Is a Prominent Presentation of the Multisystem Inflammatory Syndrome in Children: A Single-Center Report.
Acute Hepatitis Is a Prominent Presentation of the Multisystem Inflammatory Syndrome in Children: A Single-Center Report.
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急性肝炎是儿童多系统炎症综合征的明显表现：单中心报告。
DOI：
10.1002/hep.31526
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Martinez M
中科院分区：
文献类型：
--
作者：
Cantor A;Miller J;Zachariah P;DaSilva B;Margolis K;Martinez M
一种新认识到的儿童多系统炎症综合征（MIS-C）对儿童SARS-CoV-2疾病严重程度的感知产生了范式转移效应。我们报道了一组患者肝脏受累的临床和生化特征，以及肝炎的合并症。这是一项回顾性队列研究，纳入了2020年4月至5月期间在纽约长老会摩根士丹利儿童医院住院的44例MIS-C患者。我们评估了发生肝炎的患者数量，并检查了人口统计学和炎症实验室值，以确定那些肝脏受累风险较高和疾病更严重的患者。19例受试者（43%）存在肝炎，并与更严重的疾病相关。肝炎患者在就诊时休克发生率显著较高（21.1% vs. 0%，p=0.008），呼吸支持需求较大（42.1% vs. 12%，p=0.005），住院时间较长（中位数7天[IQR 5，10] vs. 4天[IQR3.5，6.5]，p<0.05）。肝炎患者的铁蛋白（706.9 vs. 334.2 mg/mL，p<0.01）、白细胞介素-6（233.9 vs. 174.7 pg/mL，p<0.05）、肌钙蛋白（83 vs. 28.5 ng/L，p<0.05）和B型利钠肽（7424.5 vs. 3209.5 pg/mL，p<0.05）水平也显著较高。一例肝功能衰竭患者还发生了多器官衰竭，需要血管加压药、血液透析和机械通气。所有患者均出院，但超过50%的患者在出院后一个月内仍有持续性肝炎。肝炎在MIS-C儿童中很常见，并且在许多情况下与更严重的表现和LFT持续升高有关。尽管这里报道了积极的结果，但鉴于对SARS-CoV-2对肝脏长期影响的了解有限，需要密切随访。
A newly recognized Multisystem Inflammatory Syndrome in Children (MIS-C) has had a paradigm-shifting effect on the perception of SARS-CoV-2 illness severity in children. We report the clinical and biochemical features of liver involvement, and the comorbidities that present with hepatitis, in a substantial cohort of patients. This is a retrospective cohort study of 44 patients with MIS-C admitted at Morgan Stanley Children’s Hospital of New York-Presbyterian during April and May 2020. We evaluated the number of patients who developed hepatitis and examined both demographics and inflammatory laboratory values to ascertain those that were at higher risk for liver involvement and more severe disease. Hepatitis was present in 19 subjects (43%) and was associated with more severe disease. Individuals with hepatitis had significantly higher rates of shock at presentation (21.1% vs. 0%, p=0.008), greater respiratory support requirement (42.1% vs. 12%, p=0.005), and longer hospitalization times (median 7-days [IQR5,10] vs 4-days [IQR3.5,6.5], p<0.05). Patients with hepatitis also had significantly higher levels of ferritin (706.9 vs. 334.2 mg/mL, p<0.01), Interleukin-6 (233.9 vs. 174.7 pg/mL, p<0.05), troponin (83 vs. 28.5 ng/L, p<0.05) and B-type Natriuretic peptide (7424.5 vs. 3209.5 pg/mL, p<0.05). The single patient with liver failure also developed multiorgan failure requiring vasopressors, hemodialysis, and mechanical ventilation. All patients were discharged, though more than 50% had persistent hepatitis up to one month after discharge. Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of LFTs in many. Despite the positive outcomes reported here, close follow-up is warranted given the limited knowledge of the long-term impact of SARS-CoV-2 on the liver.
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影响因子：
1.3
作者：
Heinz, Nicole;Griesemer, Adam;Martinez, Mercedes
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作者：
Chen Y;Fan C;Chen Y;Liu H;Wang S;Dong P;Li L;Ding H
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Ding H
影响因子：
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作者：
Guan, W.;Ni, Z.;Zhong, N.
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