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儿童多系统炎症综合征与严重急性COVID-19的特征及预后比较
作者:小柯机器人 发布时间:2021/2/28 16:02:51

美国波士顿儿童医院Adrienne G. Randolph团队比较了美国儿童青少年多系统炎症综合征(MISC)与严重急性COVID-19的特征及预后。2021年2月24日,《美国医学会杂志》发表了该成果。

儿童多系统炎症综合征(MIS-C)标准的完善可能有助于改善健康状况。

为了比较儿童青少年MIS-C与重症COVID-19的临床特点及预后,2020年3月15日至10月31日,研究组在美国31个州的66家医院招募了1116名年龄小于21岁的住院患者。MIS-C患者有发热、炎症、多系统受累、SARS-CoV-2逆转录聚合酶链反应(RT-PCR)阳性、或抗体检测结果阳性、或近期有接触史,无其他诊断。COVID-19患者的RT-PCR检测结果呈阳性,且严重累及器官系统。主要结果为表现症状、器官系统并发症、实验室生物标志物、干预措施和临床结局。

1116例患者的中位年龄为9.7岁,女性占45%,诊断为MIS-C者539例(48%),COVID-19者577例(52%)。与COVID-19患者相比,MIS-C患者中年龄为6-12岁的比例更高,非西班牙裔黑人比例更高。与COVID-19患者相比,MIS-C患者更易发生心肺受累,无呼吸系统受累的心血管疾病,和无心肺受累的皮肤粘膜疾病。

MIS-C患者中性粒细胞与淋巴细胞比率较高,C反应蛋白水平较高,血小板计数较低。共有398例(73.8%)MIS-C患者和253例(43.8%)COVID-19患者入住重症监护室,10例(1.9%)MIS-C患者和8例(1.4%)COVID-19患者在住院期间死亡。在左室收缩功能减退(34.2%)和冠状动脉瘤(13.4%)的MIS-C患者中,估计分别有91.0%和79.1%的患者在30天内恢复正常。

这一病例系列的MIS-C和COVID-19患者确定了临床表现和器官系统受累的模式,这可能有助于区分MIS-C和COVID-19。

附:英文原文

Title: Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

Author: Leora R. Feldstein, Mark W. Tenforde, Kevin G. Friedman, Margaret Newhams, Erica Billig Rose, Heda Dapul, Vijaya L. Soma, Aline B. Maddux, Peter M. Mourani, Cindy Bowens, Mia Maamari, Mark W. Hall, Becky J. Riggs, John S. Giuliano, Aalok R. Singh, Simon Li, Michele Kong, Jennifer E. Schuster, Gwenn E. McLaughlin, Stephanie P. Schwartz, Tracie C. Walker, Laura L. Loftis, Charlotte V. Hobbs, Natasha B. Halasa, Sule Doymaz, Christopher J. Babbitt, Janet R. Hume, Shira J. Gertz, Katherine Irby, Katharine N. Clouser, Natalie Z. Cvijanovich, Tamara T. Bradford, Lincoln S. Smith, Sabrina M. Heidemann, Sheemon P. Zackai, Kari Wellnitz, Ryan A. Nofziger, Steven M. Horwitz, Ryan W. Carroll, Courtney M. Rowan, Keiko M. Tarquinio, Elizabeth H. Mack, Julie C. Fitzgerald, Bria M. Coates, Ashley M. Jackson, Cameron C. Young, Mary Beth F. Son, Manish M. Patel, Jane W. Newburger, Adrienne G. Randolph, Overcoming COVID- Investigators

Issue&Volume: 2021-02-24

Abstract:

Importance  Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes.

Objective  To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19).

Setting, Design, and Participants  Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase–polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement.

Exposure  SARS-CoV-2.

Main Outcomes and Measures  Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19.

Results  Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P<.001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P<.001), and lower platelet count (<150×103 cells/μL [212/523 {41%} vs 84/486 {17%}, P<.001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days.

Conclusions and Relevance  This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19.

DOI: 10.1001/jama.2021.2091

Source: https://jamanetwork.com/journals/jama/fullarticle/2777026

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex