Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.

Autor: Sık G; Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey. drguntulu@hotmail.com., Inamlık A; Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey., Akçay N; Department of Pediatric Intensive Care, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey., Kesici S; Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey., Aygun F; Department of Pediatric Intensive Care, İstanbul University-Cerrahpaşa, İstanbul, Turkey., Kendırlı T; Department of Pediatric Intensive Care, Ankara University, Ankara, Turkey., Atay G; Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Turkey., Sandal O; Department of Pediatric Intensive Care, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey., Varol F; Department of Pediatric Intensive Care, Sancaktepe Şehit Prof. MD İlhan Varank Training and Research Hospital, İstanbul, Turkey., Ozkaya PY; Department of Pediatric Intensive Care, Ege University, Izmir, Turkey., Duyu M; Department of Pediatric Intensive Care, Goztepe Prof. MD Süleyman Yalçın City Hospital, Istanbul, Turkey., Bırbılen AZ; Department of Pediatric Intensive Care, Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep, Turkey., Ozcan S; Department of Pediatric Intensive Care, Ankara Yıldırım Beyazıt University, Ankara Children's Hospital, Ankara, Turkey., Arslan G; Department of Pediatric Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey., Kangın M; Department of Pediatric Intensive Care, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey., Bayraktar S; Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey., Altug U; Department of Pediatric Intensive Care, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey., Anıl AB; Department of Pediatric Intensive Care, Tepecik Training and Research Hospital, Izmır Katip Çelebi University, Izmir, Turkey., Havan M; Department of Pediatric Intensive Care, Mersin City Hospital, Mersin, Turkey., Yetımakman AF; Department of Pediatric Intensive Care, Kocaeli University, Kocaeli, Turkey., Dalkıran T; Department of Pediatric Intensive Care, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey., Zengın N; Department of Pediatric Intensive Care, Manisa Celal Bayar Unıversity, Manisa, Turkey., Oto A; Department of Pediatric Intensive Care, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey., Kıhtır HS; Department of Pediatric Intensive Care, Antalya Training and Research Hospital, Antalya, Turkey., Gırgın Fİ; Department of Pediatric Intensive Care, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey., Telhan L; Department of Pediatric Intensive Care, Medipol University, Istanbul, Turkey., Yıldızdas D; Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey., Yener N; Department of Pediatric Intensive Care, Samsun 19 Mayıs University, Samsun, Turkey., Yukselmıs U; Department of Pediatric Intensive Care, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey., Alakaya M; Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey., Kılınc MA; Department of Pediatric Intensive Care, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey., Celegen M; Department of Pediatric Intensive Care, Afyonkarahisar Tarining and Research Hospital, Afyon, Turkey., Dursun A; Department of Pediatric Intensive Care, Kayseri City Hospital, Kayseri, Turkey., Battal F; Department of Pediatric Intensive Care, Canakkale Onsekiz Mart University, Canakkale, Turkey., Sarı F; Department of Pediatric Intensive Care, Hatay Mustafa Kemal University, Hatay, Turkey., Ozkale M; Department of Pediatric Intensive Care, Dr Turgut NOYAN Hospital, Baskent University, Adana, Turkey., Topal S; Department of Pediatric Intensive Care, Erzurum Bölge Training and Research Hospital, Erzurum, Turkey., Kocaoglu C; Department of Pediatric Intensive Care, Konya City Hospital, Konya, Turkey., Yazar A; Department of Pediatric Intensive Care, Necmettin Erbakan University, Konya, Turkey., Alacakır N; Department of Pediatric Intensive Care, Trakya University, Edirne, Turkey., Odek C; Department of Pediatric Intensive Care, Bursa Uludağ University, Bursa, Turkey., Yaman A; Department of Pediatric Intensive Care, Istınye University Liv Hospital, Istanbul, Turkey., Cıtak A; Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2023 Aug; Vol. 94 (2), pp. 730-737. Date of Electronic Publication: 2023 Feb 22.
DOI: 10.1038/s41390-023-02518-0
Abstrakt: Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit.
Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome.
Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation.
Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
Impact: MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
(© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
Databáze: MEDLINE
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