tetano
Editor, Senior Moderator
Eur J Pediatr
. 2021 Apr 1.
doi: 10.1007/s00431-021-04052-9. Online ahead of print.
Pediatric multisystem SARS COV2 with versus without cardiac involvement: a multicenter study from Latin America
Ricardo Pignatelli[SUP] 1 [/SUP], Clara Vazquez Antona[SUP] 2 [/SUP], Ivan Romero Rivera[SUP] 3 [/SUP], Patricia Alvarez Zenteno[SUP] 4 [/SUP], Yanet Toribio Acosta[SUP] 5 [/SUP], Manuel Huertas-Qui?ones[SUP] 6 [/SUP], Carlos Alvarez Murillo[SUP] 7 [/SUP], Franklin Mendoza Torres[SUP] 7 [/SUP], Carlos Fernandez Cabalin[SUP] 8 [/SUP], Ana Galv?n Camacho[SUP] 9 [/SUP], Alex Alc?ntara P?rez[SUP] 10 [/SUP], Ana Braga Lombardi[SUP] 11 [/SUP], Andressa Mussi Soares[SUP] 12 [/SUP], Carolina Torres Garcia[SUP] 13 [/SUP], Cibelle Teixeira Borges[SUP] 14 [/SUP], Claudia Natalia Villalba[SUP] 15 [/SUP], Cristhian Ram?rez Lechado[SUP] 16 [/SUP], Deborah Trevisan Dias[SUP] 17 [/SUP], Diana Aravena Morales[SUP] 18 [/SUP], Elizabeth Mora Copete[SUP] 19 [/SUP], Guillermo Larios Goldenberg[SUP] 20 [/SUP], Jahaira Sussety Salazar[SUP] 21 [/SUP], Jessica Alchundia Moreira[SUP] 21 [/SUP], Junko Asakura[SUP] 22 [/SUP], Karla Sol?rzano Sabando[SUP] 21 [/SUP], Klebia Castello Branco[SUP] 23 [/SUP], Lida Toro Rosas[SUP] 10 [/SUP], Magna Pereira Duarte[SUP] 24 [/SUP], Mar?a Jim?nez Carbajal[SUP] 25 [/SUP], Martha Rubio Hernandez[SUP] 26 [/SUP], Mois?s Mier Mart?nez[SUP] 27 [/SUP], Nancy Garay Echeverr?a[SUP] 28 [/SUP], Olga Maza Caneva[SUP] 29 [/SUP], Patricia Romero Sepulveda[SUP] 30 [/SUP], Paulina Agurto D?az[SUP] 18 [/SUP], Ruth Rugel Pl?as[SUP] 31 [/SUP], Theo Contreras Alvarado[SUP] 32 [/SUP], Lorena Tapia Faundes[SUP] 33 [/SUP], Yeny Briones Diaz[SUP] 18 [/SUP], Justin P Zachariah[SUP] 34 [/SUP]
Affiliations
Abstract
Latin America (LATAM) children offer special insight into Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) due to high-risk race/ethnicity, variability in medical resources, diverse socioeconomic background, and numerous involved organ systems. This multinational study of LATAM youth examined the distinguishing features of acute or late multisystem SARS COV2 with versus without cardiac involvement. A consecutive sample of youth 0-18 years old (N = 98;50% male) presenting with multisystem SARS COV2 to 32 centers in 10 Latin American countries participating in a pediatric cardiac multi-imaging society were grouped as with versus without cardiac involvement, defined as abnormal echocardiographic findings or arrhythmia. Collected clinical data were analyzed by Student's t-test or Fisher's exact test. Cardiac (N = 48, 50% male) versus no cardiac (N = 50, 50% male) were similar in age; weight; nonrespiratory symptoms; and medical history. The cardiac group had 1 death and symptoms including coronary artery dilation, ejection fraction <50%, pericardial effusion, peripheral edema, arrhythmia, and pulmonary artery thrombus. The cardiac group had higher risk of ICU admission (77% vs 54%, p = 0.02); invasive ventilation (23% vs 4%,p = 0.007); vasoactive infusions (27% vs 4%, p = 0.002); prominent respiratory symptoms (60% vs 36%, p < 0.03); abnormal chest imaging (69% vs 34%, p = 0.001); troponin (33% vs 12%, p = 0.01); alanine aminotransferase (33% vs 12%, p = 0.02); and thrombocytopenia (46% vs 22%, p = 0.02). Receiver operating curve analysis showed that abnormal laboratories had 94% sensitivity and 98% negative predictive value on the need for ICU interventions.Conclusion: In LATAM children with multisystem SARS COV2, cardiac involvement was prevalent. Cardiac involvement was more likely to require ICU interventions, certain abnormal labs, and respiratory involvement. What is Known: ? SARS COV2 can be asymptomatic in children but in some cases can have serious multisystemic involvement. ? Hispanic ethnicity is purportedly at high risk of SARS COV2 in nations where they are often disadvantaged minority populations. What is New: ? Latin American children presenting with multisystem SARS COV2 frequently have cardiac involvement which was associated with ICU interventions; prominent respiratory symptoms; abnormal chest X-ray; elevated troponin, ALT, and thrombocytopenia. ? Elevated troponin, ALT or thrombocytopenia had high sensitivity and negative predictive value on the need for intensive care interventions.
Keywords: Coronary aneurysm; Myocarditis; Pediatric cardiology; SARS COV2.
. 2021 Apr 1.
doi: 10.1007/s00431-021-04052-9. Online ahead of print.
Pediatric multisystem SARS COV2 with versus without cardiac involvement: a multicenter study from Latin America
Ricardo Pignatelli[SUP] 1 [/SUP], Clara Vazquez Antona[SUP] 2 [/SUP], Ivan Romero Rivera[SUP] 3 [/SUP], Patricia Alvarez Zenteno[SUP] 4 [/SUP], Yanet Toribio Acosta[SUP] 5 [/SUP], Manuel Huertas-Qui?ones[SUP] 6 [/SUP], Carlos Alvarez Murillo[SUP] 7 [/SUP], Franklin Mendoza Torres[SUP] 7 [/SUP], Carlos Fernandez Cabalin[SUP] 8 [/SUP], Ana Galv?n Camacho[SUP] 9 [/SUP], Alex Alc?ntara P?rez[SUP] 10 [/SUP], Ana Braga Lombardi[SUP] 11 [/SUP], Andressa Mussi Soares[SUP] 12 [/SUP], Carolina Torres Garcia[SUP] 13 [/SUP], Cibelle Teixeira Borges[SUP] 14 [/SUP], Claudia Natalia Villalba[SUP] 15 [/SUP], Cristhian Ram?rez Lechado[SUP] 16 [/SUP], Deborah Trevisan Dias[SUP] 17 [/SUP], Diana Aravena Morales[SUP] 18 [/SUP], Elizabeth Mora Copete[SUP] 19 [/SUP], Guillermo Larios Goldenberg[SUP] 20 [/SUP], Jahaira Sussety Salazar[SUP] 21 [/SUP], Jessica Alchundia Moreira[SUP] 21 [/SUP], Junko Asakura[SUP] 22 [/SUP], Karla Sol?rzano Sabando[SUP] 21 [/SUP], Klebia Castello Branco[SUP] 23 [/SUP], Lida Toro Rosas[SUP] 10 [/SUP], Magna Pereira Duarte[SUP] 24 [/SUP], Mar?a Jim?nez Carbajal[SUP] 25 [/SUP], Martha Rubio Hernandez[SUP] 26 [/SUP], Mois?s Mier Mart?nez[SUP] 27 [/SUP], Nancy Garay Echeverr?a[SUP] 28 [/SUP], Olga Maza Caneva[SUP] 29 [/SUP], Patricia Romero Sepulveda[SUP] 30 [/SUP], Paulina Agurto D?az[SUP] 18 [/SUP], Ruth Rugel Pl?as[SUP] 31 [/SUP], Theo Contreras Alvarado[SUP] 32 [/SUP], Lorena Tapia Faundes[SUP] 33 [/SUP], Yeny Briones Diaz[SUP] 18 [/SUP], Justin P Zachariah[SUP] 34 [/SUP]
Affiliations
- PMID: 33791862
- DOI: 10.1007/s00431-021-04052-9
Abstract
Latin America (LATAM) children offer special insight into Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) due to high-risk race/ethnicity, variability in medical resources, diverse socioeconomic background, and numerous involved organ systems. This multinational study of LATAM youth examined the distinguishing features of acute or late multisystem SARS COV2 with versus without cardiac involvement. A consecutive sample of youth 0-18 years old (N = 98;50% male) presenting with multisystem SARS COV2 to 32 centers in 10 Latin American countries participating in a pediatric cardiac multi-imaging society were grouped as with versus without cardiac involvement, defined as abnormal echocardiographic findings or arrhythmia. Collected clinical data were analyzed by Student's t-test or Fisher's exact test. Cardiac (N = 48, 50% male) versus no cardiac (N = 50, 50% male) were similar in age; weight; nonrespiratory symptoms; and medical history. The cardiac group had 1 death and symptoms including coronary artery dilation, ejection fraction <50%, pericardial effusion, peripheral edema, arrhythmia, and pulmonary artery thrombus. The cardiac group had higher risk of ICU admission (77% vs 54%, p = 0.02); invasive ventilation (23% vs 4%,p = 0.007); vasoactive infusions (27% vs 4%, p = 0.002); prominent respiratory symptoms (60% vs 36%, p < 0.03); abnormal chest imaging (69% vs 34%, p = 0.001); troponin (33% vs 12%, p = 0.01); alanine aminotransferase (33% vs 12%, p = 0.02); and thrombocytopenia (46% vs 22%, p = 0.02). Receiver operating curve analysis showed that abnormal laboratories had 94% sensitivity and 98% negative predictive value on the need for ICU interventions.Conclusion: In LATAM children with multisystem SARS COV2, cardiac involvement was prevalent. Cardiac involvement was more likely to require ICU interventions, certain abnormal labs, and respiratory involvement. What is Known: ? SARS COV2 can be asymptomatic in children but in some cases can have serious multisystemic involvement. ? Hispanic ethnicity is purportedly at high risk of SARS COV2 in nations where they are often disadvantaged minority populations. What is New: ? Latin American children presenting with multisystem SARS COV2 frequently have cardiac involvement which was associated with ICU interventions; prominent respiratory symptoms; abnormal chest X-ray; elevated troponin, ALT, and thrombocytopenia. ? Elevated troponin, ALT or thrombocytopenia had high sensitivity and negative predictive value on the need for intensive care interventions.
Keywords: Coronary aneurysm; Myocarditis; Pediatric cardiology; SARS COV2.