背景:儿童多系统炎症综合征(MIS-C)是一种罕见且严重的全身性炎症性疾病,发生在严重急性呼吸道综合征冠状病毒2(SARS-CoV-2)感染后。本研究旨在探讨其临床表现,与儿科重症监护病房(PICU)入院相关的危险因素,以及台湾MIS-C患儿的结局。
方法:对2022年6月至2023年2月在长庚纪念医院诊断为MIS-C的儿科患者进行了回顾性分析,林口,台湾。人口统计数据,临床特征,实验室发现,治疗方式,并对结局进行收集和分析.
结果:28例MIS-C患者,包括9个男孩和19个女孩,平均年龄5.3±3.8岁,已注册。大多数病例(78.6%)是在台湾第一波COVID-19大流行后诊断的。观察到的主要临床表现是发热(100%),皮疹(64.3%),心动过速(46.4%),和呕吐(46.4%)。9名患者(32.1%)因低血压或神经系统表现而入院。高水平的带状白细胞,降钙素原,铁蛋白,D-二聚体,凝血酶原时间,NT-proBNP,到达时降低的血小板水平与PICU入院有关(p=3.9×10-2,9×10-3,4×10-3,1×10-3,5×10-3,4.1×10-2,3.4×10-2,分别)。1例心律失常(3.5%)和冠状动脉异常,包括2例(7.1%)扩张和1例(3.5%)小动脉瘤。不管入住ICU,治疗后无患者出现收缩功能障碍或死亡.
结论:台湾的MIS-C病例具有良好的预后。尽管三分之一的患者需要进入PICU,MIS-C病例均未导致严重的心血管疾病发病率或死亡率。这项研究为台湾MIS-C患儿入院PICU的临床表现和结果提供了有价值的见解。
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious systemic inflammatory disorder that occurs following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This
study aims to investigate the clinical manifestations, risk factors associated with pediatric intensive care unit (PICU) admission, and outcome among children with MIS-C in Taiwan.
METHODS: A retrospective analysis was conducted among pediatric patients diagnosed with MIS-C between June 2022 and February 2023 at Chang Gung Memorial Hospital, Linkou, Taiwan. Data on demographics, clinical features, laboratory findings, treatment modalities, and outcomes were collected and analyzed.
RESULTS: Twenty-eight MIS-C patients, including 9 boys and 19 girls, with an average age of 5.3 ± 3.8 years old, were enrolled. Most of the cases (78.6%) were diagnosed following the first pandemic wave of COVID-19 in Taiwan. The leading clinical manifestations observed were fever (100%), skin rash (64.3%), tachycardia (46.4%), and vomiting (46.4%). Nine patients (32.1%) were admitted to the PICU due to hypotension or neurological manifestations. Higher levels of band-form white blood cells, procalcitonin, ferritin, d-dimer, prothrombin time, NT-proBNP, and lower platelet levels on arrival were associated with PICU admission (p = 3.9 × 10-2 ,9 × 10-3 , 4 × 10-3 ,1 × 10-3 , 5 × 10-3 , 4.1 × 10-2 , and 3.4 × 10-2 , respectively). Arrhythmia in one case (3.5%) and coronary artery abnormalities, including dilatation in two cases (7.1%) and small aneurysms in one case (3.5%) were identified. Regardless of ICU admission, no patients experienced systolic dysfunction or mortality following treatment.
CONCLUSIONS: MIS-C cases in Taiwan have a favorable outcome. Although one-third of the patients required PICU admission, none of the MIS-C cases resulted in severe cardiovascular morbidity or mortality. This
study provides valuable insights into the clinical manifestations and outcomes associated with PICU admission in children with MIS-C in Taiwan.