tetano
Editor, Senior Moderator
J Intensive Care Med
. 2024 Feb 28:8850666241233189.
doi: 10.1177/08850666241233189. Online ahead of print. 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
Jaime Fernández-Sarmiento[SUP] 1 [/SUP], Lorena Acevedo[SUP] 1 [/SUP], Laura Fernanda Niño-Serna[SUP] 2 [/SUP], Raquel Boza[SUP] 3 [/SUP], Jimena García-Silva[SUP] 4 [/SUP], Adriana Yock-Corrales[SUP] 5 [/SUP], Marco A Yamazaki-Nakashimada[SUP] 6 [/SUP], Enrique Faugier-Fuentes[SUP] 7 [/SUP], Olguita Del Águila[SUP] 8 [/SUP], German Camacho-Moreno[SUP] 9 [/SUP], Dora Estripeaut[SUP] 10 [/SUP], Iván F Gutiérrez[SUP] 11 [/SUP], Kathia Luciani[SUP] 12 [/SUP], Graciela Espada[SUP] 13 [/SUP], Martha I Álvarez-Olmos[SUP] 14 [/SUP], Paola Pérez-Camacho[SUP] 15 [/SUP], Saulo Duarte-Passos[SUP] 16 [/SUP], Maria C Cervi[SUP] 17 [/SUP], Edwin M Cantillano[SUP] 18 [/SUP], Beatriz A Llamas-Guillén[SUP] 19 [/SUP], Patricia Saltigeral-Simental[SUP] 20 [/SUP], Javier Criales[SUP] 21 [/SUP], Enrique Chacon-Cruz[SUP] 22 23 [/SUP], Miguel García-Domínguez[SUP] 24 [/SUP], Karla L Borjas Aguilar[SUP] 25 [/SUP], Daniel Jarovsky[SUP] 26 [/SUP], Gabriela Ivankovich-Escoto[SUP] 27 [/SUP], Adriana H Tremoulet[SUP] 28 [/SUP], Rolando Ulloa-Gutierrez[SUP] 29 30 31 [/SUP]; REKAMLATINA-3 Study Group Investigators 32
Affiliations
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.
Keywords: COVID-19; Latin America; MIS-C; PIMS-TS; SARS-CoV2; children; critical care; inflammatory; mortality; shock.
. 2024 Feb 28:8850666241233189.
doi: 10.1177/08850666241233189. Online ahead of print. 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
Jaime Fernández-Sarmiento[SUP] 1 [/SUP], Lorena Acevedo[SUP] 1 [/SUP], Laura Fernanda Niño-Serna[SUP] 2 [/SUP], Raquel Boza[SUP] 3 [/SUP], Jimena García-Silva[SUP] 4 [/SUP], Adriana Yock-Corrales[SUP] 5 [/SUP], Marco A Yamazaki-Nakashimada[SUP] 6 [/SUP], Enrique Faugier-Fuentes[SUP] 7 [/SUP], Olguita Del Águila[SUP] 8 [/SUP], German Camacho-Moreno[SUP] 9 [/SUP], Dora Estripeaut[SUP] 10 [/SUP], Iván F Gutiérrez[SUP] 11 [/SUP], Kathia Luciani[SUP] 12 [/SUP], Graciela Espada[SUP] 13 [/SUP], Martha I Álvarez-Olmos[SUP] 14 [/SUP], Paola Pérez-Camacho[SUP] 15 [/SUP], Saulo Duarte-Passos[SUP] 16 [/SUP], Maria C Cervi[SUP] 17 [/SUP], Edwin M Cantillano[SUP] 18 [/SUP], Beatriz A Llamas-Guillén[SUP] 19 [/SUP], Patricia Saltigeral-Simental[SUP] 20 [/SUP], Javier Criales[SUP] 21 [/SUP], Enrique Chacon-Cruz[SUP] 22 23 [/SUP], Miguel García-Domínguez[SUP] 24 [/SUP], Karla L Borjas Aguilar[SUP] 25 [/SUP], Daniel Jarovsky[SUP] 26 [/SUP], Gabriela Ivankovich-Escoto[SUP] 27 [/SUP], Adriana H Tremoulet[SUP] 28 [/SUP], Rolando Ulloa-Gutierrez[SUP] 29 30 31 [/SUP]; REKAMLATINA-3 Study Group Investigators 32
Affiliations
- PMID: 38414438
- DOI: 10.1177/08850666241233189
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.
Keywords: COVID-19; Latin America; MIS-C; PIMS-TS; SARS-CoV2; children; critical care; inflammatory; mortality; shock.