In-hospital unfavorable outcomes of MIS-C during 2020-2022: a systematic review.

Autor: Alvarado-Gamarra G; Department of Pediatrics, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. galvaradogamarra@gmail.com.; Instituto de Investigación Nutricional, Lima, Perú. galvaradogamarra@gmail.com.; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú. galvaradogamarra@gmail.com., Alcalá-Marcos K; Cardiology. Instituto Nacional Cardiovascular 'Carlos Alberto Peschiera Carrillo' - INCOR, Lima, Perú., Balmaceda-Nieto P; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú.; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, USA., Visconti-Lopez FJ; Sociedad Científica de Estudiantes de Medicina - UPC, Lima, Perú., Torres-Balarezo P; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú.; Universidad Central del Ecuador, Quito, Ecuador., Morán-Mariños C; Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú., Velásquez-Rimachi V; Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú., Chavez-Malpartida SS; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú.; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú., Alva-Díaz C; Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú.; Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2024 Oct 01. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1007/s00431-024-05787-x
Abstrakt: Studies on the severity in multisystem inflammatory syndrome in children (MIS-C) show heterogeneous results and may not reflect a global perspective. This systematic review aims to estimate the frequency of in-hospital unfavorable outcomes in patients with MIS-C over the 3 years since the onset of the SARS-CoV-2 pandemic. A systematic search was conducted in Medline, Scopus, Embase, Cochrane, Web of Science, Scielo, and preprint repositories until December 15, 2022. Study selection and data extraction were evaluated independently. The primary outcomes were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and death. Additionally, we evaluated cardiovascular-related outcomes. We performed a random-effects model meta-analysis and assessed the certainty of the evidence. Fifty-seven studies (n = 13 254) were included. The frequency of ICU admission was 44.7% (95% CI 38.8-50.7), 11.9% for IMV (95% CI 9.6-14.4), and 2.0% for death (95% CI 1.3-3.0). The requirement of vasoactive/inotropic drugs was 40.1% (95% CI 35.9-44.4), 7.9% for coronary aneurysm (95% CI 4.1-12.7), 30.7% for decreased left ventricle ejection fraction (LVEF) (95% CI 26.3-35.4), and 29.7% for myocarditis (95% CI 18.4-42.4). We assess the included evidence as being of very low certainty. Finally, excess COVID-19 mortality by country and the diagnostic criteria for MIS-C (CDC compared to WHO) were associated with a higher frequency of ICU admissions. The year of study conduction (2022 compared to 2020) was associated with a lower frequency of IMV.
Conclusion: The frequency of in-hospital unfavorable outcomes in patients with MIS-C was high. Well-designed studies are needed to explore other heterogeneity sources.
Protocol Registration: CRD42021284878.
What Is Known: • Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious condition linked to SARS-CoV-2. Studies on the severity of MIS-C show heterogeneous results. These findings may not be representative of the reality in other regions, making it challenging to draw generalizable conclusions.
What Is New: • Over the 3 years since the onset of the SARS-CoV-2 pandemic, our systematic review has shown that the frequency of in-hospital unfavorable outcomes in patients with MIS-C is high, with a very low certainty of the evidence. Our results reflect the reality from a global perspective, across different countries with varying income levels. • The main sources of heterogeneity in the frequency of severe outcomes could be explained by the excess mortality due to COVID-19 in each country, the type of diagnostic criteria for MIS-C, and the year the study was conducted.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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