Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network.

Autor: Fernández-Sarmiento J; Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia., Acevedo L; Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia., Niño-Serna LF; Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia., Boza R; Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional de Niños 'Dr Carlos Sáenz Herrera,' Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica., García-Silva J; Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México., Yock-Corrales A; Servicio de Emergencias, Hospital Nacional de Niños 'Dr Carlos Sáenz Herrera,' Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica., Yamazaki-Nakashimada MA; Departamento de Inmunología Clínica, Instituto Nacional de Pediatría, Ciudad de México, México., Faugier-Fuentes E; Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México., Del Águila O; Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú., Camacho-Moreno G; Unidad de Infectología Pediátrica, Fundación Hospital Pediátrico La Misericordia (HOMI), Bogotá, Colombia., Estripeaut D; Servicio de Infectología, Hospital del Niño Dr José Renán Esquivel, Ciudad de Panamá, Panamá., Gutiérrez IF; Servicio de Infectología, Clínica Infantil Colsubsidio, Bogotá, Colombia., Luciani K; Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Ciudad de Panamá, Panamá., Espada G; Servicio de Reumatología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina., Álvarez-Olmos MI; Servicio de Infectología Pediátrica, Fundación Cardioinfantil IC, Bogotá, Colombia., Pérez-Camacho P; Servicio de Infectología, Fundación Valle del Lili & Departamento de Pediatría, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia., Duarte-Passos S; Hospital Universitario de Faculdade de Medicina de Jundiai, Sao Paolo, Brazil., Cervi MC; Serviço de Infectología, Faculdade de Medicina de Ribeirāo Preto, Universidade de Sāo Paulo, Sao Paulo, Brazil., Cantillano EM; Unidad de Cuidados Intensivos Pediátricos, Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro de Sula, Honduras., Llamas-Guillén BA; Servicio de Alergología e Inmunología, Hospital del Niño Morelense, Cuernavaca, Morelos, México., Saltigeral-Simental P; Servicio de Infectología, Star Médica Hospital Infantil Privado e Instituto Nacional de Pediatría, Ciudad de México, México., Criales J; Fundación Clínica Infantil Club Noel, Cali, Colombia., Chacon-Cruz E; Servicio de Infectología. Hospital General de Tijuana, Tijuana, México.; Think Vaccines LLC, Houston, Texas, USA., García-Domínguez M; Servicio de Alergología e Inmunología, Hospital Pediátrico de Sinaloa 'Dr Rigoberto Aguilar Pico,' Sinaloa, México., Aguilar KLB; Servicio de Inmunología, Hospital María, Especialidades Pediátricas e Instituto Hondureño de Seguridad Social, Hospital de Especialidades, Tegucigalpa, Honduras., Jarovsky D; Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil., Ivankovich-Escoto G; Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños 'Dr Carlos Sáenz Herrera,' Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica., Tremoulet AH; Department of Pediatrics, University of California San Diego (UCSD) & Rady Children's Hospital, San Diego, California, USA., Ulloa-Gutierrez R; Servicio de Infectología Pediátrica, Hospital Nacional de Niños 'Dr Carlos Sáenz Herrera,' Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica.; Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica.; Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica.
Jazyk: angličtina
Zdroj: Journal of intensive care medicine [J Intensive Care Med] 2024 Aug; Vol. 39 (8), pp. 785-793. Date of Electronic Publication: 2024 Feb 28.
DOI: 10.1177/08850666241233189
Abstrakt: Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P  < 0.01) with no difference in the frequency of coronary abnormalities ( P  = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P  = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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