Multisystem Inflammatory Syndrome in US Children and Adolescents
Multisystem Inflammatory Syndrome in US Children and Adolescents
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DOI：
10.1056/nejmoa2021680
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发表时间：
2020-07-23
影响因子：
158.5
通讯作者：
Randolph, Adrienne G.
中科院分区：
文献类型：
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作者：
Feldstein, Leora R.;Rose, Erica B.;Randolph, Adrienne G.
本报告描述了来自26个州的21岁以下多系统炎症综合征患者的流行病学和临床病程。许多人在综合征发作前至少1至2周感染了SARS-CoV-2。患者的中位年龄为8.3岁，73%的患者以前是健康的。背景了解儿童多系统炎症综合征（MIS-C）的流行病学和临床病程及其与2019冠状病毒病（Covid-19）的时间关联非常重要，因为该综合征具有临床和公共卫生意义。方法我们于2020年3月15日至5月20日在美国各地的儿科健康中心对MIS-C进行了有针对性的监测。病例定义包括六个标准：导致住院治疗的严重疾病，年龄小于21岁，发热持续至少24小时，实验室炎症证据，多系统器官受累，以及严重急性呼吸综合征冠状病毒2型感染证据（SARS-CoV-2）基于逆转录酶聚合酶链反应（RT-PCR）、抗体检测或过去一个月接触过Covid-19患者。临床医生将数据提取到标准化表格中。结果我们报告了26个州的186例MIS-C患者。中位年龄为8.3岁，115名患者（62%）为男性，135名（73%）此前健康，131名（70%）经RT-PCR或抗体检测为SARS-CoV-2阳性，164名（88%）在2020年4月16日之后住院。器官系统受累包括171例患者（92%）的胃肠道系统、149例患者（80%）的心血管系统、142例患者（76%）的血液系统、137例患者（74%）的皮肤粘膜系统和131例患者（70%）的呼吸系统。中位住院时间为7天（四分位距，4 - 10）; 148例患者（80%）接受重症监护，37例（20%）接受机械通气，90例（48%）接受血管活性支持，4例（2%）死亡。15例患者（8%）记录到冠状动脉瘤（z评分>= 2.5），74例（40%）记录到川崎样特征。大多数患者（171例[92%]）至少有四种生物标志物升高，表明炎症。免疫调节治疗的使用很常见：144例（77%）使用静脉注射免疫球蛋白，91例（49%）使用糖皮质激素，38例（20%）使用白细胞介素-6或1 RA抑制剂。结论SARS-CoV-2相关的儿童多系统炎性综合征可导致健康儿童和青少年严重和危及生命的疾病。（由疾病控制和预防中心资助。
This report describes the epidemiology and clinical course of patients younger than 21 years of age from 26 states who had multisystem inflammatory syndrome. Many were infected with SARS-CoV-2 at least 1 to 2 weeks before syndrome onset. The median age of the patients was 8.3 years, and 73% were previously healthy.Background Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. Methods We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. Results We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores >= 2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). Conclusions Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)