Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers...
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| Veröffentlicht in: | European journal of pediatrics 2024-04, Vol.183 (4), p.1693-1702 |
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| creator | Lampidi, Stavroula Maritsi, Despoina Charakida, Marietta Eleftheriou, Irini Farmaki, Evangelia Spyridis, Nikos Charisi, Konstantina Vantsi, Petrina Filippatos, Filippos Skourti, Kleopatra Papadopoulou-Alataki, Efimia Papadopoulou-Legbelou, Kyriaki Kampouridou, Parthena Grivea, Ioanna N. Vergadi, Eleni Gkentzi, Despoina Dimou, Despina Koletsi, Patra Fotis, Lampros Liakopoulou, Theodota Agrafiotou, Aikaterini Kourtesi, Katerina Tsolas, Georgios Kafetzis, Dimitrios Papaevangelou, Vassiliki Dimitriou, Gabriel Galanakis, Emmanouil Syrogiannopoulos, George A. Spoulou, Vassiliki Michos, Athanasios Roilides, Emmanuel Tsolia, Maria N. |
| description | Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 10
9
/mm
3
. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (
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| doi_str_mv | 10.1007/s00431-023-05383-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11001744</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3034541972</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-876f4ade9b6cb35c056e3e14abfc201b9cd1ea83f225757bfcf2deb7bc3e699b3</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhS1ERR_wB1ggS2zKIsXPOGZTVVe0VGrFAlhbjjPpTUnsi-0U5d_j9pbSsujK1sx3znh8EHpLyRElRH1MhAhOK8J4RSRveCVfoD0qOKsoUfXLR_ddtJ_SNSkiTZtXaJc3jIqGkj0ULucxD2lJGSY8-H6002RziAtOi-9imKBUsVsPYxfB48PL82_V6sMnfIK9zUPwv4cOsAvjaNsQS-UGcMpzt9yq8hrwWQT4iTdhM493_Gu009sxwZv78wD9OP38ffWluvh6dr46uaicUDJXjap7YTvQbe1aLh2RNXCgwra9Y4S22nUUbMN7xqSSqlR71kGrWseh1rrlB-h467uZ2wk6Bz5HO5pNHCYbFxPsYJ52_LA2V-HG0PK1VAlRHA7vHWL4NUPKZhqSg7KphzAnwzTThGlJdUHf_4dehzn6sp_hhAspqFasUGxLuRhSitA_vIYScxuo2QZqSqDmLlAji-jd4z0eJH8TLADfAqm0_BXEf7Ofsf0DseeuKA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3034541972</pqid></control><display><type>article</type><title>Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Lampidi, Stavroula ; Maritsi, Despoina ; Charakida, Marietta ; Eleftheriou, Irini ; Farmaki, Evangelia ; Spyridis, Nikos ; Charisi, Konstantina ; Vantsi, Petrina ; Filippatos, Filippos ; Skourti, Kleopatra ; Papadopoulou-Alataki, Efimia ; Papadopoulou-Legbelou, Kyriaki ; Kampouridou, Parthena ; Grivea, Ioanna N. ; Vergadi, Eleni ; Gkentzi, Despoina ; Dimou, Despina ; Koletsi, Patra ; Fotis, Lampros ; Liakopoulou, Theodota ; Agrafiotou, Aikaterini ; Kourtesi, Katerina ; Tsolas, Georgios ; Kafetzis, Dimitrios ; Papaevangelou, Vassiliki ; Dimitriou, Gabriel ; Galanakis, Emmanouil ; Syrogiannopoulos, George A. ; Spoulou, Vassiliki ; Michos, Athanasios ; Roilides, Emmanuel ; Tsolia, Maria N.</creator><creatorcontrib>Lampidi, Stavroula ; Maritsi, Despoina ; Charakida, Marietta ; Eleftheriou, Irini ; Farmaki, Evangelia ; Spyridis, Nikos ; Charisi, Konstantina ; Vantsi, Petrina ; Filippatos, Filippos ; Skourti, Kleopatra ; Papadopoulou-Alataki, Efimia ; Papadopoulou-Legbelou, Kyriaki ; Kampouridou, Parthena ; Grivea, Ioanna N. ; Vergadi, Eleni ; Gkentzi, Despoina ; Dimou, Despina ; Koletsi, Patra ; Fotis, Lampros ; Liakopoulou, Theodota ; Agrafiotou, Aikaterini ; Kourtesi, Katerina ; Tsolas, Georgios ; Kafetzis, Dimitrios ; Papaevangelou, Vassiliki ; Dimitriou, Gabriel ; Galanakis, Emmanouil ; Syrogiannopoulos, George A. ; Spoulou, Vassiliki ; Michos, Athanasios ; Roilides, Emmanuel ; Tsolia, Maria N.</creatorcontrib><description>Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 10
9
/mm
3
. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (
p
< 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.
Conclusion
: MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity.
What is Known:
• MIS-C is an infrequent but serious disease entity.
• Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems.
What is New:
• NT-pro-BNP levels may provide a better prediction and monitoring of the disease course.
• Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.</description><identifier>ISSN: 1432-1076</identifier><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-023-05383-5</identifier><identifier>PMID: 38214810</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acute Kidney Injury ; Adrenal Cortex Hormones ; Child ; Children ; Comorbidity ; Coronary artery disease ; Corticosteroids ; COVID-19 - complications ; COVID-19 - epidemiology ; COVID-19 - therapy ; Disease Progression ; Ferritin ; Greece ; Heart diseases ; Humans ; Immunoglobulins ; Immunomodulation ; Inflammation ; Intravenous administration ; Kidneys ; Male ; Medicine ; Medicine & Public Health ; Multisystem inflammatory syndrome in children ; Myocarditis ; Patients ; Pediatrics ; Pericarditis ; Population studies ; Retrospective Studies ; Risk factors ; Severe acute respiratory syndrome coronavirus 2 ; Shock ; Steroids ; Systemic Inflammatory Response Syndrome ; Troponin</subject><ispartof>European journal of pediatrics, 2024-04, Vol.183 (4), p.1693-1702</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-876f4ade9b6cb35c056e3e14abfc201b9cd1ea83f225757bfcf2deb7bc3e699b3</citedby><cites>FETCH-LOGICAL-c475t-876f4ade9b6cb35c056e3e14abfc201b9cd1ea83f225757bfcf2deb7bc3e699b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00431-023-05383-5$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00431-023-05383-5$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38214810$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lampidi, Stavroula</creatorcontrib><creatorcontrib>Maritsi, Despoina</creatorcontrib><creatorcontrib>Charakida, Marietta</creatorcontrib><creatorcontrib>Eleftheriou, Irini</creatorcontrib><creatorcontrib>Farmaki, Evangelia</creatorcontrib><creatorcontrib>Spyridis, Nikos</creatorcontrib><creatorcontrib>Charisi, Konstantina</creatorcontrib><creatorcontrib>Vantsi, Petrina</creatorcontrib><creatorcontrib>Filippatos, Filippos</creatorcontrib><creatorcontrib>Skourti, Kleopatra</creatorcontrib><creatorcontrib>Papadopoulou-Alataki, Efimia</creatorcontrib><creatorcontrib>Papadopoulou-Legbelou, Kyriaki</creatorcontrib><creatorcontrib>Kampouridou, Parthena</creatorcontrib><creatorcontrib>Grivea, Ioanna N.</creatorcontrib><creatorcontrib>Vergadi, Eleni</creatorcontrib><creatorcontrib>Gkentzi, Despoina</creatorcontrib><creatorcontrib>Dimou, Despina</creatorcontrib><creatorcontrib>Koletsi, Patra</creatorcontrib><creatorcontrib>Fotis, Lampros</creatorcontrib><creatorcontrib>Liakopoulou, Theodota</creatorcontrib><creatorcontrib>Agrafiotou, Aikaterini</creatorcontrib><creatorcontrib>Kourtesi, Katerina</creatorcontrib><creatorcontrib>Tsolas, Georgios</creatorcontrib><creatorcontrib>Kafetzis, Dimitrios</creatorcontrib><creatorcontrib>Papaevangelou, Vassiliki</creatorcontrib><creatorcontrib>Dimitriou, Gabriel</creatorcontrib><creatorcontrib>Galanakis, Emmanouil</creatorcontrib><creatorcontrib>Syrogiannopoulos, George A.</creatorcontrib><creatorcontrib>Spoulou, Vassiliki</creatorcontrib><creatorcontrib>Michos, Athanasios</creatorcontrib><creatorcontrib>Roilides, Emmanuel</creatorcontrib><creatorcontrib>Tsolia, Maria N.</creatorcontrib><title>Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 10
9
/mm
3
. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (
p
< 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.
Conclusion
: MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity.
What is Known:
• MIS-C is an infrequent but serious disease entity.
• Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems.
What is New:
• NT-pro-BNP levels may provide a better prediction and monitoring of the disease course.
• Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.</description><subject>Acute Kidney Injury</subject><subject>Adrenal Cortex Hormones</subject><subject>Child</subject><subject>Children</subject><subject>Comorbidity</subject><subject>Coronary artery disease</subject><subject>Corticosteroids</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - therapy</subject><subject>Disease Progression</subject><subject>Ferritin</subject><subject>Greece</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Immunomodulation</subject><subject>Inflammation</subject><subject>Intravenous administration</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multisystem inflammatory syndrome in children</subject><subject>Myocarditis</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pericarditis</subject><subject>Population studies</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Shock</subject><subject>Steroids</subject><subject>Systemic Inflammatory Response Syndrome</subject><subject>Troponin</subject><issn>1432-1076</issn><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtv1TAQhS1ERR_wB1ggS2zKIsXPOGZTVVe0VGrFAlhbjjPpTUnsi-0U5d_j9pbSsujK1sx3znh8EHpLyRElRH1MhAhOK8J4RSRveCVfoD0qOKsoUfXLR_ddtJ_SNSkiTZtXaJc3jIqGkj0ULucxD2lJGSY8-H6002RziAtOi-9imKBUsVsPYxfB48PL82_V6sMnfIK9zUPwv4cOsAvjaNsQS-UGcMpzt9yq8hrwWQT4iTdhM493_Gu009sxwZv78wD9OP38ffWluvh6dr46uaicUDJXjap7YTvQbe1aLh2RNXCgwra9Y4S22nUUbMN7xqSSqlR71kGrWseh1rrlB-h467uZ2wk6Bz5HO5pNHCYbFxPsYJ52_LA2V-HG0PK1VAlRHA7vHWL4NUPKZhqSg7KphzAnwzTThGlJdUHf_4dehzn6sp_hhAspqFasUGxLuRhSitA_vIYScxuo2QZqSqDmLlAji-jd4z0eJH8TLADfAqm0_BXEf7Ofsf0DseeuKA</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Lampidi, Stavroula</creator><creator>Maritsi, Despoina</creator><creator>Charakida, 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Despoina ; Dimou, Despina ; Koletsi, Patra ; Fotis, Lampros ; Liakopoulou, Theodota ; Agrafiotou, Aikaterini ; Kourtesi, Katerina ; Tsolas, Georgios ; Kafetzis, Dimitrios ; Papaevangelou, Vassiliki ; Dimitriou, Gabriel ; Galanakis, Emmanouil ; Syrogiannopoulos, George A. ; Spoulou, Vassiliki ; Michos, Athanasios ; Roilides, Emmanuel ; Tsolia, Maria N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-876f4ade9b6cb35c056e3e14abfc201b9cd1ea83f225757bfcf2deb7bc3e699b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Kidney Injury</topic><topic>Adrenal Cortex Hormones</topic><topic>Child</topic><topic>Children</topic><topic>Comorbidity</topic><topic>Coronary artery disease</topic><topic>Corticosteroids</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - epidemiology</topic><topic>COVID-19 - therapy</topic><topic>Disease Progression</topic><topic>Ferritin</topic><topic>Greece</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Immunoglobulins</topic><topic>Immunomodulation</topic><topic>Inflammation</topic><topic>Intravenous administration</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multisystem inflammatory syndrome in children</topic><topic>Myocarditis</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pericarditis</topic><topic>Population studies</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Shock</topic><topic>Steroids</topic><topic>Systemic Inflammatory Response Syndrome</topic><topic>Troponin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lampidi, Stavroula</creatorcontrib><creatorcontrib>Maritsi, Despoina</creatorcontrib><creatorcontrib>Charakida, 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Katerina</creatorcontrib><creatorcontrib>Tsolas, Georgios</creatorcontrib><creatorcontrib>Kafetzis, Dimitrios</creatorcontrib><creatorcontrib>Papaevangelou, Vassiliki</creatorcontrib><creatorcontrib>Dimitriou, Gabriel</creatorcontrib><creatorcontrib>Galanakis, Emmanouil</creatorcontrib><creatorcontrib>Syrogiannopoulos, George A.</creatorcontrib><creatorcontrib>Spoulou, Vassiliki</creatorcontrib><creatorcontrib>Michos, Athanasios</creatorcontrib><creatorcontrib>Roilides, Emmanuel</creatorcontrib><creatorcontrib>Tsolia, Maria N.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lampidi, Stavroula</au><au>Maritsi, Despoina</au><au>Charakida, Marietta</au><au>Eleftheriou, Irini</au><au>Farmaki, Evangelia</au><au>Spyridis, Nikos</au><au>Charisi, Konstantina</au><au>Vantsi, Petrina</au><au>Filippatos, Filippos</au><au>Skourti, Kleopatra</au><au>Papadopoulou-Alataki, Efimia</au><au>Papadopoulou-Legbelou, Kyriaki</au><au>Kampouridou, Parthena</au><au>Grivea, Ioanna N.</au><au>Vergadi, Eleni</au><au>Gkentzi, Despoina</au><au>Dimou, Despina</au><au>Koletsi, Patra</au><au>Fotis, Lampros</au><au>Liakopoulou, Theodota</au><au>Agrafiotou, Aikaterini</au><au>Kourtesi, Katerina</au><au>Tsolas, Georgios</au><au>Kafetzis, Dimitrios</au><au>Papaevangelou, Vassiliki</au><au>Dimitriou, Gabriel</au><au>Galanakis, Emmanouil</au><au>Syrogiannopoulos, George A.</au><au>Spoulou, Vassiliki</au><au>Michos, Athanasios</au><au>Roilides, Emmanuel</au><au>Tsolia, Maria N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>183</volume><issue>4</issue><spage>1693</spage><epage>1702</epage><pages>1693-1702</pages><issn>1432-1076</issn><issn>0340-6199</issn><eissn>1432-1076</eissn><abstract>Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 10
9
/mm
3
. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (
p
< 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.
Conclusion
: MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity.
What is Known:
• MIS-C is an infrequent but serious disease entity.
• Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems.
What is New:
• NT-pro-BNP levels may provide a better prediction and monitoring of the disease course.
• Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38214810</pmid><doi>10.1007/s00431-023-05383-5</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1076 |
| ispartof | European journal of pediatrics, 2024-04, Vol.183 (4), p.1693-1702 |
| issn | 1432-1076 0340-6199 1432-1076 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11001744 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Acute Kidney Injury Adrenal Cortex Hormones Child Children Comorbidity Coronary artery disease Corticosteroids COVID-19 - complications COVID-19 - epidemiology COVID-19 - therapy Disease Progression Ferritin Greece Heart diseases Humans Immunoglobulins Immunomodulation Inflammation Intravenous administration Kidneys Male Medicine Medicine & Public Health Multisystem inflammatory syndrome in children Myocarditis Patients Pediatrics Pericarditis Population studies Retrospective Studies Risk factors Severe acute respiratory syndrome coronavirus 2 Shock Steroids Systemic Inflammatory Response Syndrome Troponin |
| title | Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population |
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