Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Aug 2023
01 Aug 2023
Historique:
medline:
23
10
2023
pubmed:
23
2
2023
entrez:
22
2
2023
Statut:
ppublish
Résumé
Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.
Identifiants
pubmed: 36811547
doi: 10.1097/PEC.0000000000002914
pii: 00006565-990000000-00216
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
555-561Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
New York State Department of Health. Health advisory: pediatric multi-system inflammatory syndrome potentially associated with coronavirus disease (COVID-19) in children. Available at: https://www.health.ny.gov/press/releases/2020/docs/2020-05-06_covid19_pediatric_inflammatory_syndrome.pdf . Accessed May 24, 2022.
Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronoavirus disease 2019 (COVID-19). Available at https://emergency.cdc.gov/han/2020/han00432.asp . Accessed May 24, 2022.
Royal College of Paediatrics and Child Health Guidance. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available at: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf . Accessed May 26, 2022.
Belay ED, Abrams J, Oster ME, et al. Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic. JAMA Pediatr . 2021;175:837–845.
Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med . 2020;383:334–346.
Belot A, Antona D, Renolleau S, et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveill . 2020;25:2001010. doi:10.2807/1560-7917.Es.2020.25.22.2001010.
doi: 10.2807/1560-7917.Es.2020.25.22.2001010
Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study. BMJ . 2020;369:m2094.
Dufort EM, Koumans EH, Chow EJ, et al. Multisystem inflammatory syndrome in children in New York state. N Engl J Med . 2020;383:347–358.
Waseem M, Shariff MA, Tay ET, et al. Multisystem inflammatory syndrome in children. J Emerg Med . 2022;62:28–37.
Kline JN, Isbey SC, McCollum NL, et al. Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department. Am J Emerg Med . 2022;51:69–75.
Belhadjer Z, Meot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation . 2020;142:429–436.
Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis . 2020;79:999–1006.
Ramcharan T, Nolan O, Lai CY, et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr Cardiol . 2020;41:1391–1401.
Abrams JY, Oster ME, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health . 2021;5:323–331.
Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA . 2020;324:259–269.
Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA . 2021;325:1074–1087.
Capone CA, Subramony A, Sweberg T, et al. Characteristics, cardiac involvement, and outcomes of multisystem inflammatory syndrome of childhood associated with severe acute respiratory syndrome coronavirus 2 infection. J Pediatr . 2020;224:141–145.
Alsaied T, Tremoulet AH, Burns JC, et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation . 2021;143:78–88.
Godfred-Cato S, Bryant B, Leung J, et al. COVID-19-associated multisystem inflammatory syndrome in children—United States, March–July 2020. MMWR Morb Mortal Wkly Rep . 2020;69:1074–1080.
Feldstein LR, Rose EB, Randolph AG. Multisystem inflammatory syndrome in children in the United States. Reply. N Engl J Med . 2020;383:1794–1795.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet . 2007;370:1453–1457.
World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: scientific brief. Available at: https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 . Accessed June 7, 2022.
Vogel TP, Top KA, Karatzios C, et al. Multisystem inflammatory syndrome in children and adults (MIS-C/A): case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine . 2021;39:3037–3049.
Son MBF, Murray N, Friedman K, et al. Multisystem inflammatory syndrome in children—initial therapy and outcomes. N Engl J Med . 2021;385:23–34.
Hanson KE, Caliendo AM, Arias CA, et al. The Infectious Diseases Society of America guidelines on the diagnosis of COVID-19: molecular diagnostic testing. Clin Infect Dis . 2021. doi:10.1093/cid/ciab048.
doi: 10.1093/cid/ciab048
Cruz AT, Lane RD, Balamuth F, et al. Updates on pediatric sepsis. J Am Coll Emerg Physicians Open . 2020;1:981–993.
Scott HF, Colborn KL, Sevick CJ, et al. Development and validation of a model to predict pediatric septic shock using data known 2 hours after hospital arrival. Pediatr Crit Care Med . 2021;22:16–26.
Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet . 2020;395:1607–1608.
Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation . 2020;142(16 suppl 2):S469–S523.
Goldman RD, Amin P, Macpherson A. Language and length of stay in the pediatric emergency department. Pediatr Emerg Care . 2006;22:640–643.
Rosychuk RJ, Rowe BH. Type of facility influences lengths of stay of children presenting to high volume emergency departments. BMC Pediatr . 2020;20:500.
Barata IAMS, Wu M, Sharieff G, et al. A comparison of length of stay between admitted and discharged pediatric patients in the emergency department (Abstract 307). Ann Emerg Med . 2013;62(supplement):S111.
Harris PA, Taylor R, Thielke R, et al. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform . 2009;42:377–381.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform . 2019;95:103208.
R Development Core Team. R: A language and environment for statistical computing. Available at: https://www.R-project.org . Accessed June 7, 2022.
R Studio Team. RStudio: Integrated Developmeny for R. Available at: http://www.rstudio.com . Accessed June 7, 2022.
Matsubara D, Kauffman HL, Wang Y, et al. Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol . 2020;76:1947–1961.
Domínguez-Rodríguez S, Villaverde S, Sanz-Santaeufemia FJ, et al. A Bayesian model to predict COVID-19 severity in children. Pediatr Infect Dis J . 2021;40:e287–e293.
Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med . 2020;21:e52–e106.
Valverde I, Singh Y, Sanchez-de-Toledo J, et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation . 2021;143:21–32.
Godfred-Cato S, Abrams JY, Balachandran N, et al. Distinguishing multisystem inflammatory syndrome in children from COVID-19, Kawasaki disease and toxic shock syndrome. Pediatr Infect Dis J . 2022;41:315–323.
Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children. JAMA . 2021;325:855–864.
Gupta N, Talathi S. Factors differentiating multisystem inflammatory syndrome in children (MIS-C) from severe/critical COVID-19 infection in children. Indian Pediatr . 2022;59:120–124.
Geva A, Patel MM, Newhams MM, et al. Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents. EClinicalMedicine . 2021;40:101112.
Cheung EW, Zachariah P, Gorelik M, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA . 2020;324:294–296.
DeLaroche AM, Stankovic C, Ehrman RR, et al. Emergency department screening for multisystem inflammatory syndrome (MIS-C) in children. Am J Emerg Med . 2021;46:736–738.
Carlin RF, Fischer AM, Pitkowsky Z, et al. Discriminating multisystem inflammatory syndrome in children requiring treatment from common febrile conditions in outpatient settings. J Pediatr . 2021;229:26–32.e2.
Wool GD, Miller JL. The impact of COVID-19 disease on platelets and coagulation. Pathobiology . 2021;88:15–27.
Lee J, Park SS, Kim TY, et al. Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study. Cancers (Basel) . 2021;13:471.
Miller AD, Zambrano LD, Yousaf AR, et al. Multisystem inflammatory syndrome in children-United States, February 2020–July 2021. Clin Infect Dis . 2022;75:e1165–e1175. doi:10.1093/cid/ciab1007.
doi: 10.1093/cid/ciab1007