Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe.

Adolescent Antibodies, Viral / blood Arrhythmias, Cardiac / blood Biomarkers / blood C-Reactive Protein / metabolism COVID-19 / blood Child Child, Preschool Europe / epidemiology Female Ferritins / blood Fibrin Fibrinogen Degradation Products / metabolism Humans Immunoglobulin G / blood Immunoglobulin M / blood Infant Interleukin-6 / blood Male Natriuretic Peptide, Brain / blood Pandemics Peptide Fragments / blood Pericardial Effusion / blood SARS-CoV-2 Shock / blood Systemic Inflammatory Response Syndrome / blood

COVID-19 cardiology cardiovascular diseases pandemics pediatric multisystem inflammatory disease, COVID-19 related

Journal

Circulation

ISSN: 1524-4539

Titre abrégé: Circulation

Pays: United States

ID NLM: 0147763

Informations de publication

Date de publication:
05 01 2021

Historique:

pubmed: 10 11 2020

medline: 12 1 2021

entrez: 9 11 2020

Statut: ppublish

Résumé

The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support ( Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.

Sections du résumé

BACKGROUND

METHODS

This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included.

RESULTS

A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (

CONCLUSIONS

Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.120.050065 PMID: 33166189

pubmed: 33166189

doi: 10.1161/CIRCULATIONAHA.120.050065

doi:

Substances chimiques

Antibodies, Viral 0

Biomarkers 0

Fibrin Fibrinogen Degradation Products 0

IL6 protein, human 0

Immunoglobulin G 0

Immunoglobulin M 0

Interleukin-6 0

Peptide Fragments 0

fibrin fragment D 0

pro-brain natriuretic peptide (1-76) 0

Natriuretic Peptide, Brain 114471-18-0

C-Reactive Protein 9007-41-4

Ferritins 9007-73-2

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

21-32

Investigateurs

Xavier Iriart (X)

Jelena Hubrechts (J)

Irene Mariette Kuipers (IM)

Ana R Sousa (AR)

Andrea Donti (A)

Abigail Sharpe (A)

Zdenka Reinhardt (Z)

Francesca Cairello (F)

Daniel De Wolf (D)

Marisa Vieira (M)

Cecilia Lazea (C)

Ferran Gran (F)

Constancio Medrano-Lopez (C)

Almudena Ortiz-Garrido (A)

Vladislav Vukomanovic (V)

Bernadette Elisabeth Brent (BE)

Ornella Milanesi (O)

Wendy Dewals (W)

Begoña Manso (B)

Emanuela Valsangiacomo-Buchel (E)

Andreia Francisco (A)

Marie-Christine Seghaye (MC)

Isabelle Loeckx (I)

Moises Rodriguez-Gonzalez (M)

Susana Maria ReyGarcía (SM)

Victoria C Ziesenitz (VC)

Giulia Bordin (G)

Gabriela Doros (G)

Gernot Grangl (G)

Shalan Uaid Fadl (SU)

Karl Viktor Perminow (KV)

Fernando Centeno (F)

Fatima Pinto (F)

Jussi Niemelä (J)

Hari Krishnan Kanthimathinathan (HK)

Paula Cecilia Randanne (PC)

Cezary Niszczota (C)

Gian Vincenzo Zuccotti (GV)

Inés Leoz Gordillo (IL)

Madhu Obeyasekhara (M)

Catherine Armstrong (C)

Karina Butler (K)

Matteo Ciuffreda (M)

Anna Maria Villar (AM)

Naga Pappula (N)

Roberta Caorsi (R)

Davinder Singh (D)

Saravanan Durairaj (S)

Karen McLeod (K)

Giulio Calcagni (G)

Youssef Quizad (Y)

Marc Gewillig (M)

Taco Willem Kuijpers (TW)

Rita Ataide (R)

Marianna Fabi (M)

Tara Bharucha (T)

Khushnood Abbas (K)

Silvia Alessandra Magrass (SA)

James Wong (J)

Daniela Iacob (D)

Joan Balcells (J)

Nuria GilVillanueva (N)

Victorio Cuenca-Peiro (V)

Ivana Cerovi (I)

Avishay Sarfatt (A)

Mahmoud Zaqout (M)

Elia Sanchez-Valderrabanos (E)

Janet Kelly-Geyer (J)

Faim Diogo (F)

Nathalie Cajgfinger (N)

Mascart Françoise (M)

Fernando Rueda-Nuñez (F)

Matthias Gorenflo (M)

Alessandra Grison (A)

Delia Mihailov (D)

Martin Koestenberger (M)

Carlos Alcalde (C)

Conceiçao Trigo (C)

Anita Arola (A)

Katarina Hanseus (K)