Importance In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation. Objectives To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders. Design, Setting, and Participants Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019. Exposures Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization. Main Outcomes and Measures Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders. Results Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 33 girls [57%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively). Conclusions and Relevance In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.

中文翻译：

---

58 名患有与 SARS-CoV-2 暂时相关的小儿炎症多系统综合征的儿童的临床特征

重要性 在 2019 年冠状病毒病发病率较高的社区中，出现了儿童出现发烧和炎症等不寻常综合症的报告。目的 描述符合与严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) (PIMS-TS) 暂时相关的儿科炎症多系统综合征 (PIMS-TS) 标准的住院儿童的临床和实验室特征，并将这些特征与其他儿科炎症性疾病进行比较。设计、设置和参与者 2020 年 3 月 23 日至 5 月 16 日期间收治的来自英格兰 8 家医院的 58 名儿童的病例系列，这些儿童有持续发烧和炎症实验室证据，符合已发布的 PIMS-TS 定义。最终随访日期为2020年5月22日。通过病历审查提取临床和实验室特征，并与川崎病（KD）（n = 1132）、KD休克综合征（n = 45) 和中毒性休克综合征 (n = 37)，这些患者于 2002 年至 2019 年间曾在欧洲和美国的医院住院。 暴露 符合英国 PIMS-TS 定义标准的儿童的体征和症状以及实验室和影像学结果、美国和世界卫生组织。主要结果和措施 符合 PIMS-TS 定义标准的儿童的临床、实验室和影像学特征，并与其他儿科炎症性疾病的特征进行比较。结果 确定了 58 名符合 PIMS-TS 标准的儿童（中位年龄 9 岁 [四分位数间距 {IQR}，5.7-14]；33 名女孩 [57%]）。58 名患者中有 15 名 (26%) 的 SARS-CoV-2 聚合酶链反应检测结果呈阳性，46 名患者中有 40 名 (87%) 的 SARS-CoV-2 IgG 检测结果呈阳性。总共 58 名患者中有 45 名 (78%) 有当前或既往感染 SARS-CoV-2 的证据。所有儿童均出现发烧和非特异性症状，包括呕吐（26/58 [45%]）、腹痛（31/58 [53%]）和腹泻（30/58 [52%]）。58 例中有 30 例 (52%) 出现皮疹，58 例中有 26 例 (45%) 出现结膜充血。实验室评估与明显的炎症一致，例如，C 反应蛋白（229 mg/L [IQR，156-338]，在 58 例中的 58 例中进行评估）和铁蛋白（610 μg/L [IQR，359-1280]，在 58 例中评估）在 58 中的 53 中）。在 58 名儿童中，29 名出现休克（有心肌功能障碍的生化证据）并需要正性肌力支持和液体复苏（其中 23/29 [79%] 接受机械通气）；13 人符合美国心脏协会对 KD 的定义，23 人有发烧和炎症，但没有休克或 KD 的特征。八名患者（14%）出现冠状动脉扩张或动脉瘤。PIMS-TS 与 KD 和 KD 休克综合征的比较显示出临床和实验室特征的差异，包括年龄较大（中位年龄，9 岁 [IQR，5.7-14] vs 2.7 岁 [IQR，1.4-4.7] 和 3.8 岁[ IQR，分别为 0.2-18]），炎症标志物如 C 反应蛋白的升高（中位数为 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] 和 193 mg/L [IQR, 83- 237]，分别）。结论和相关性 在符合 PIMS-TS 标准的住院儿童病例系列中，存在各种各样的体征和症状以及疾病严重程度，从发烧和炎症到心肌损伤、休克和冠状动脉瘤的发展。与川崎病和川崎病休克综合征患者的比较提供了对该综合征的深入了解，并表明该疾病不同于其他儿科炎症实体。