Acute Hepatitis Is a Prominent Presentation of the Multisystem Inflammatory Syndrome in Children: A Single‐Center Report
| Autor: | Bernardo DaSilva, Philip Zachariah, Mercedes Martinez, Jonathan Miller, Amanda Cantor, Kara Gross Margolis |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Adolescent Pneumonia Viral Risk Assessment Severity of Illness Index Article Statistics Nonparametric Hepatitis Cohort Studies 03 medical and health sciences 0302 clinical medicine Liver Function Tests Interquartile range Internal medicine Severity of illness medicine Humans Hospital Mortality Child Pandemics Retrospective Studies Hepatology medicine.diagnostic_test business.industry Incidence COVID-19 Retrospective cohort study Hospitals Pediatric medicine.disease Systemic Inflammatory Response Syndrome Systemic inflammatory response syndrome 030104 developmental biology Child Preschool Acute Disease Cohort Female New York City 030211 gastroenterology & hepatology Coronavirus Infections Liver function tests business Cohort study |
| Zdroj: | Hepatology |
| ISSN: | 1527-3350 0270-9139 |
| DOI: | 10.1002/hep.31526 |
| Popis: | A newly recognized multisystem inflammatory syndrome in children (MIS-C) has had a paradigm-shifting effect on the perception of severe acute respiratory syndrome, coronavirus-2 (SARS-CoV-2) illness severity in children. We report the clinical and biochemical features of liver involvement, and the comorbidities that present with hepatitis, in a substantial cohort of patients.This is a retrospective cohort study of 44 patients with MIS-C admitted at Morgan Stanley Children's Hospital of New York-Presbyterian during April and May 2020. We evaluated the number of patients who developed hepatitis and examined both demographics and inflammatory laboratory values to ascertain those that were at higher risk for liver involvement and more severe disease. Hepatitis was present in 19 subjects (43%) and was associated with more severe disease. Persons with hepatitis had significantly higher rates of shock at presentation (21.1% vs. 0%; P = 0.008), greater respiratory support requirement (42.1% vs. 12%; P = 0.005), and longer hospitalization times (median, 7 [interquartile range {IQR}, 5, 10] vs. 4 days [IQR, 3.5, 6.5]; P 0.05). Patients with hepatitis also had significantly higher levels of ferritin (706.9 vs. 334.2 mg/mL; P 0.01), interleukin-6 (233.9 vs. 174.7 pg/mL; P 0.05), troponin (83.0 vs. 28.5 ng/L; P 0.05), and B-type natriuretic peptide (7,424.5 vs. 3,209.5 pg/mL; P 0.05). The single patient with liver failure also developed multiorgan failure requiring vasopressors, hemodialysis, and mechanical ventilation. All patients were discharged, though50% had persistent hepatitis up to 1 month after discharge.Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests in many. Despite the positive outcomes reported here, close follow-up is warranted given the limited knowledge of the long-term impact of SARS-CoV-2 on the liver. |
| Databáze: | OpenAIRE |
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