Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Multi-institutional Study from New York City.
儿童多系统炎症综合征 (MIS-C) 与 SARS-CoV-2 感染相关: 一项来自纽约市的多机构研究。
- 作者列表："Kaushik S","Aydin SI","Derespina KR","Bansal PB","Kowalsky S","Trachtman R","Gillen JK","Perez MM","Soshnick SH","Conway EE Jr","Bercow A","Seiden HS","Pass RH","Ushay HM","Ofori-Amanfo G","Medar SS
OBJECTIVE:To assess clinical characteristics and outcomes of SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C). STUDY DESIGN:Children with MIS-C admitted to pediatric intensive care units (PICU) in New York City between April 23 and May 23, 2020 were included. Demographic and clinical data were collected. RESULTS:Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction (LVEF) was found in 63% of patients with median EF of 46.6% (IQR 39.5, 52.8). C-reactive protein, procalcitonin, D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation (ECMO) in 1 (3%), and intra-aortic balloon pump in 1 (3%). The LVEF normalized in 95% of those with depressed EF. All patients were discharged home with median duration of PICU stay of 4.7 (4, 8) days and hospital stay of 7.8 (6, 10.1) days. One (3%) patient died after withdrawal of care secondary to stroke while on ECMO. CONCLUSIONS:Critically ill children with COVID-19 associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.
目的: 探讨儿童 SARS-CoV-2 相关多系统炎症综合征 (MIS-C) 的临床特点及转归。 研究设计: 纳入 2020 年 4 月 23 日至 5 月 23 日期间入住纽约市儿科重症监护病房 (PICU) 的 MIS-C 患儿。收集人口统计学和临床资料。 结果: 在 33 例 MIS-C 患儿中，中位年龄为 10 岁; 61% 为男性; 45% 为西班牙裔/拉丁裔; 39% 为黑人。45% 存在合并症。发热 (93%) 和呕吐 (69%) 是最常见的表现症状。63% 的患者左室射血分数 (LVEF) 降低，中位 EF 为 46.6% (IQR 39.5，52.8)。所有患者的 C 反应蛋白、降钙素原、 D-二聚体和 b型钠尿肽前体水平均升高。用于治疗，静脉注射免疫球蛋白 18 例 (54%)，皮质类固醇 17 例 (51%)，tocilizumab 12 例 (36%)，remdesivir 7 例 (21%),血管加压药 17 例 (51%)，机械通气 5 例 (15%)，体外膜肺氧合 (ECMO) 1 例 (3 )%,和主动脉内球囊反搏 1 例 (3%)。95% 的 EF 抑郁者 LVEF 正常化。所有患者均出院回家，PICU 住院时间中位数为 4.7 (4,8) 天，住院时间中位数为 7.8 (6,10.1) 天。1 例 (3%) 患者在 ECMO 期间死于卒中继发护理退出后。 结论: 新型冠状病毒肺炎相关 MIS-C 的危重患儿的严重程度比以前描述的范围更广，但仍然需要仔细的支持性重症监护。快速、完全的临床和心肌恢复几乎是普遍的。
METHODS:INTRODUCTION:Continuous albuterol is a mainstay in management of pediatric status asthmaticus. While the National Heart Lung and Blood Institute Asthma Guidelines suggest 0.5 mg/kg/hr as the recommended dosage, there is a paucity of evidence comparing different weight based rates on hospital outcomes. METHODS:Patients requiring continuous albuterol for asthma exacerbation from January 2015 to December 2016 were identified using ICD codes. The concentration of albuterol (5 mg/h - 20 mg/h) and the duration of treatment were used to determine total albuterol administration. After dividing by patient weight, average weight based doses were divided into equal quintiles. Unadjusted and length of stay adjusted for age, initial asthma severity score, and administration of magnesium were compared among the quintiles. The same multivariate analysis was used for duration of continuous albuterol. RESULTS:533 hospitalizations for asthma were identified of which 289 received continuous albuterol. Weight based dosage quintiles ranged from lowest (0.07 - 0.29 mg/kg/hr) to the highest (>0.76 - 3.2 mg/kg/hr). Baseline characteristics were similar aside from age, race, and magnesium administration. There was no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles. CONCLUSION:No optimal weight based dose of continuous albuterol was found. Further investigation is needed to see if lower amounts of continuous albuterol may be as efficacious as higher doses. This could improve cost of status asthmaticus management and limit the number of adverse events associated with high exposure to continuous albuterol.
METHODS:Abstract Background We investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP). Methods We retrospectively reviewed the medical records of patients with AEP treated at the Armed Forces Capital Hospital between May 2012 and May 2017. We used correlation analyses to assess the association between PEC/BEP and clinical outcomes in AEP patients. Receiver operating characteristic (ROC) curve analyses were used to calculate the cut-off value for BEP that categorised patients requiring a significant oxygen supply. The BAL/blood eosinophil (BBE) score was introduced to stratify patients with peripheral eosinophilia and elevated BEP. Clinical characteristics and outcomes were compared between the different groups. Multiple logistic regression was performed for significant oxygen requirements using two different models using age, C-reactive protein (CRP), smoking duration, and BBE score (model 1) and age, CRP, BEP, and PEC (model 2). Results Among the 338 patients, 99.7% were male, and their mean age was 20.4 ± 1.4 years. Only 0.6% of patients were never smokers and the mean number of smoking days was 26.2 ± 25.4. Correlation analyses revealed that both the PaO2/FiO2 ratio and duration of oxygen supply were associated with BEP. ROC curve analyses indicated a cut-off level of 41.5%. Patients with a high BBE score had favourable outcomes in terms of hypoxemia, hospital days, intensive care unit admission, oxygen supply days, and steroid treatment days. Multiple logistic regression revealed that BEP and BBE score tended to be associated with significant oxygen requirements. Conclusions In this study, we revealed that both peripheral and BAL eosinophilia is associated with favourable outcomes in AEP patients.
METHODS:Background. Extensive studies have focused on the diagnosis and treatment of Mycoplasma pneumoniae infection; however, rare studies investigated the posttreatment conditions. We analyzed the carrying status of M. pneumoniae in the respiratory tract of children before and after treatment. Methods. Ninety-two children with M. pneumoniae pneumonia were included in this study. Clinical data were obtained from each patient, and pharyngeal swab sampling was performed at preliminary diagnosis and discharge. Real-time PCR and dilution quantitative culture were utilized to determine the DNA quantification and number of viable M. pneumoniae from samples collected upon preliminary diagnosis and discharge. Results. All the 92 cases showed DNA positivity upon preliminary diagnosis, serum IgM antibody was detected in 80 patients, and positivity of M. pneumoniae culture was observed in 82 cases. Upon discharge, the M. pneumoniae nucleotide and culture positivity were detected in 87 and 49 cases, respectively. The content of viable M. pneumoniae was 10–104 CCU/mL and 10–102 CCU/mL in the preliminary diagnosis samples and discharge samples, respectively. Conclusions. Real-time PCR was rapid and effective for the qualitative diagnosis of M. pneumoniae at the early stage, but it cannot be used to evaluate the prognosis of patients with M. pneumoniae infection. Quantitative analysis for M. pneumoniae DNA could not directly reflex the viable strain content.