OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p =0.034); pediatric SARS (67% vs. 13%, p =0.008); hypoxemia (83% vs. 23%, p =0.006); and arterial hypotension (50% vs. 3%, p =0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p =0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p =0.007) and the median D-dimer, troponin T, and ferritin levels ( p <0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p =0.003), mechanical ventilation (83% vs. 7%, p <0.001), vasoactive agent use (83% vs. 3%, p <0.001), shock (83% vs. 5%, p <0.001), cardiac abnormalities (100% vs. 2%, p <0.001), and death (67% vs. 3%, p <0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p =0.003), intravenous immunoglobulin therapy (67% vs. 2%, p <0.001), aspirin therapy (50% vs. 0%, p <0.001), and current acute renal replacement therapy (50% vs. 2%, p =0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p =0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p =0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p <0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.
【저자키워드】 COVID-19, children, Multisystem inflammatory syndrome, Adolescent, Outcome, Immunosuppression, 【초록키워드】 coronavirus disease, SARS-CoV-2, Intravenous immunoglobulin, coronavirus, therapy, intensive care, mechanical ventilation, cross-sectional, pediatric, Infection, C-reactive protein, D-dimer, outcome, abdominal pain, diarrhea, MIS-C, Shock, Hypoxemia, Patient, Control, death, Oxygen therapy, Aspirin, serological, Admission, patients, association, renal replacement therapy, D-dimer level, Frequency, Inflammatory, manifestation, criteria, regression analysis, acute respiratory syndrome, Pediatric patient, study group, 95%CI, syndrome, center, vomiting, high mortality rate, Univariate analysis, positive, abnormality, laboratory-confirmed, gastrointestinal involvement, tested, collected, significantly, diagnosed, significantly higher, presenting, ferritin level, the median, vasoactive agent, with COVID-19, 【제목키워드】 Inflammatory, Pediatric patient, syndrome, high mortality, with COVID-19,