Ashraf S Harahsheh1,2, Anita Krishnan1,2, Roberta L DeBiasi2,3,4, Laura J Olivieri1,2, Christopher Spurney1,2, Mary T Donofrio1,2, Russell R Cross1,2, Matthew P Sharron2,5, Lowell H Frank1,2, Charles I Berul1,2, Adam Christopher1, Niti Dham1,2, Hemalatha Srinivasalu2,6, Tova Ronis2,6, Karen L Smith2,7, Jaclyn N Kline2,8, Kavita Parikh2,7, David Wessel1,2, James E Bost2,9, Sarah Litt1, Ashley Austin1, Jing Zhang1, Craig A Sable1,2. 1. Division of Cardiology, Children's National Hospital, Washington, DC, USA. 2. Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA. 3. Microbiology, Immunology and Tropical Medicine, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA. 4. Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA. 5. Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA. 6. Division of Rheumatology, Children's National Hospital, Washington, DC, USA. 7. Division of Hospitalist Medicine, Children's National Hospital, Washington, DC, USA. 8. Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA. 9. Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA.
Abstract
BACKGROUND: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. OBJECTIVES: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. METHODS: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum. RESULTS: Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). CONCLUSION: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
BACKGROUND: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. OBJECTIVES: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. METHODS: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum. RESULTS: Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). CONCLUSION: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
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