背景:儿童多系统炎症综合征(MIS-C)是一种严重的疾病,具有不可预测的病程和严重的心源性休克风险。我们的目标是(A)比较COVID-19大流行的MIS-C表型,(b)确定与重症监护需求和生物制剂治疗相关的特征。
方法:0-18岁青年,履行世界卫生组织对MIS-C的案例定义,这项队列研究包括在COVID-19大流行的前四波(2020年5月至2021年12月)期间入院的艾伯塔省儿童医院。人口统计,临床,生物化学,成像,和治疗数据被捕获。
结果:57例MIS-C患者(中位年龄6岁,范围0-17)包括在内。30名患者(53%)需要重症监护。第三波或第四波患者(表示为大流行的第二阶段)出现较高的铁蛋白峰值(µg/l,中位数(IQR)=1134(409-1806)与370(249-629),P=0.001),NT-proBNP(ng/l,中位数(IQR)=12,217(3013-27,161)与3213(1216-8483),P=0.02)和D-二聚体(mg/l,中位数(IQR)=4.81(2.24-5.37)2.01(1.27-3.34),P=0.004)级,肝酶异常的患病率较高(n(%)=17(68)与11(34),P=0.02),低白蛋白血症(n(%)=24(100)vs.25(81)P=0.03)和血小板减少症(n(%)18(72)vs.11(34),P=0.007)与前两波(第一阶段)中的患者相比。这些患者对无创/机械通气的需求较高(n(%)4(16)与0(0),P=0.03)。无监督聚类分析将47%的患者分类为正确的波,将74%的患者分类为正确的大流行阶段。在所有应用的多元回归模型中,NT-proBNP是导致重症监护需求的唯一重要因素。生物制剂治疗与CRP峰值显着相关(mg/l(中位数,IQR=240.9(132.9-319.4)vs.155.8(101.0-200.7),P=0.02)和铁蛋白水平(µg/l,中位数(IQR)=1380(509-1753)与473(280-296))。
结论:大流行后期的MIS-C患者表现出更严重的表型,反映了不同SARS-CoV-2变体的影响。NT-proBNP成为与重症监护需求相关的最关键特征,强调监测的重要性。
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need and treatment with biologic agents.
METHODS: Youth aged 0-18 years, fulfilling the World Health Organization case definition of MIS-C, and admitted to the Alberta Children\'s Hospital during the first four waves of the COVID-19 pandemic (May 2020-December 2021) were included in this cohort
study. Demographic, clinical, biochemical, imaging, and treatment data were captured.
RESULTS: Fifty-seven MIS-C patients (median age 6 years, range 0-17) were included. Thirty patients (53%) required intensive care. Patients in the third or fourth wave (indicated as phase 2 of the pandemic) presented with higher peak ferritin (µg/l, median (IQR) = 1134 (409-1806) vs. 370 (249-629), P = 0.001), NT-proBNP (ng/l, median (IQR) = 12,217 (3013-27,161) vs. 3213 (1216-8483), P = 0.02) and D-dimer (mg/l, median (IQR) = 4.81 (2.24-5.37) vs. 2.01 (1.27-3.34), P = 0.004) levels, and higher prevalence of liver enzyme abnormalities (n(%) = 17 (68) vs. 11 (34), P = 0.02), hypoalbuminemia (n(%) = 24 (100) vs. 25 (81), P = 0.03) and thrombocytopenia (n(%) 18 (72) vs. 11 (34), P = 0.007) compared to patients in the first two waves (phase 1). These patients had a higher need of non-invasive/mechanical ventilation (n(%) 4 (16) vs. 0 (0), P = 0.03). Unsupervised clustering analyses classified 47% of the patients in the correct wave and 74% in the correct phase of the pandemic. NT-proBNP was the only significant contributor to the need for intensive care in all applied multivariate regression models. Treatment with biologic agents was significantly associated with peak CRP (mg/l (median, IQR = 240.9 (132.9-319.4) vs. 155.8 (101.0-200.7), P = 0.02) and ferritin levels (µg/l, median (IQR) = 1380 (509-1753) vs. 473 (280-296)).
CONCLUSIONS: MIS-C patients in a later stage of the pandemic displayed a more severe phenotype, reflecting the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most crucial feature associated with intensive care need, underscoring the importance of monitoring.