Предикторы тяжелого течения мультисистемного воспалительного синдрома, ассоциированного с новой коронавирусной инфекцией COVID-19, у детей: результаты ретроспективно-проспективного многоцентрового исследования

Илья Сергеевич Аврусин; Наталья Николаевна Абрамова; Константин Евгеньевич Белозеров; Олеся Станиславовна Ефремова; Людмила Владимировна Брегель; Глеб Валентинович Кондратьев; Елена Александровна Дондурей; Алла Ароновна Вильниц; Юлия Евгеньевна Константинова; Татьяна Егоровна Бурцева; Екатерина Игоревна Винникова; Евгения Алексеевна Исупова; Татьяна Леонидовна Корнишина; Вера Васильевна Масалова; Мария Васильевна Редькина; Ирина Владимировна Солодкова; Ольга Валерьевна Калашникова; Вячеслав Григорьевич Часнык; Юрий Станиславович Александрович; Михаил Михайлович Костик

The predictors of severe course of multisystem inflammatory syndrome associated with the new coronavirus infection COVID-19 in children: results of a retrospective-prospective multicenter study

Ilia S. Avrusin St. Petersburg State Pediatric Medical University
Natalia N. Abramova St. Petersburg State Pediatric Medical University
Konstantin E. Belozerov St. Petersburg State Pediatric Medical University
Olesya S. Efremova Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research Center
Lyudmila V. Bregel Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research Center
Gleb V. Kondratiev St. Petersburg State Pediatric Medical University
Elena A. Dondurey A.A. Smorodintsev Influenza Research Institute; N.F. Filatov Children’s City Clinical Hospital No. 5
Alla A. Vilnitz St. Petersburg State Pediatric Medical University; Children’s Scientific and Clinical Center of Infectious Diseases
Yulia E. Konstantinova Children’s Scientific and Clinical Center of Infectious Diseases
Tatiana E. Burtseva North-Eastern Federal University; Yakut Science Centre of Complex Medical Problems
Ekaterina I. Vinnikova St. Petersburg State Pediatric Medical University
Evgeniya A. Isupova St. Petersburg State Pediatric Medical University
Tatiana L. Kornishina St. Petersburg State Pediatric Medical University
Vera V. Masalova St. Petersburg State Pediatric Medical University
Maria V. Redkina St. Petersburg State Pediatric Medical University
Irina V. Solodkova St. Petersburg State Pediatric Medical University
Olga V. Kalashnikova St. Petersburg State Pediatric Medical University
Vyacheslav G. Chasnyk St. Petersburg State Pediatric Medical University
Yuri S. Alexandrovich St. Petersburg State Pediatric Medical University
Mikhail M. Kostik St. Petersburg State Pediatric Medical University

Abstract

BACKGROUND: Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases. AIM: To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit. MATERIALS AND METHODS: The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of “multisystem inflammatory syndrome associated with COVID-19 in children”. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 — patients hospitalized in the intensive care unit (n = 84, 50.6%), and group 2 — patients who did not need hospitalization in the intensive care unit (n = 82, 49.4%). RESULTS: Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed. CONCLUSIONS: The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.