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Abstract：
Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.
摘要：
背景和目标：儿童多系统炎症综合征（MIS-C）对医疗保健系统提出了挑战，尤其是频繁的心脏介入.目前的回顾性观察研究旨在总结MISC儿童心血管受累的类型和程度，并发现实验室之间可能的关联。炎症，以及影像学异常和主要临床表型使用聚类分析。材料和方法：我们提出了一项回顾性观察单中心研究，包括51名符合MIS-C标准的儿童。结果：53%的受试者出现至少一种心血管受累迹象(即，动脉低血压,心力衰竭,心包积液,心肌功能障碍,心包炎无积液,心肌炎,冠状动脉炎,心悸,和ECG异常）。使用影像学评估的30/41儿童（73％）发现了急性心包炎：14/30（46.7％）有少量心包积液，16/30（53.3％）无心包积液。心包炎患儿CRP水平显著升高(21.6±13mg/dLvs.13.9±11mg/dL,p=0.035),与无心包积液的儿童相比，有少量心包积液的儿童的血清IL-6水平更高（191±53ng/Lvs.88±27纳克/升，p=0.041)。与女性相比，可检测到心包积液的心包炎明显更频繁。男性受试者,72%vs.30%(p=0.007)。层次聚类分析显示了两个聚类：聚类1包括没有心血管症状的儿童，第2组概括了轻度和重度心血管受累的MIS-C儿童，合并心包炎,心肌炎,心力衰竭,和低血压。此外，来自第2组的受试者显示纤维蛋白原水平显着升高（5.7±0.3vs.4.6±0.3，p=0.03）和IL-6（158±36ng/mL与66±22ng/mL，p=0.032),炎症标志物提示细胞因子风暴。结论：我们的结果证实，应筛查患有少症状MIS-C或疑似长期COVID-19的儿童是否可能涉及心脏病。
