Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.,The New England Journal of Medicine

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Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.
The New England Journal of Medicine ( IF 158.5 ) Pub Date : 2020-06-29 , DOI: 10.1056/nejmoa2021680
Leora R Feldstein ₁ , Erica B Rose ₁ , Steven M Horwitz ₁ , Jennifer P Collins ₁ , Margaret M Newhams ₁ , Mary Beth F Son ₁ , Jane W Newburger ₁ , Lawrence C Kleinman ₁ , Sabrina M Heidemann ₁ , Amarilis A Martin ₁ , Aalok R Singh ₁ , Simon Li ₁ , Keiko M Tarquinio ₁ , Preeti Jaggi ₁ , Matthew E Oster ₁ , Sheemon P Zackai ₁ , Jennifer Gillen ₁ , Adam J Ratner ₁ , Rowan F Walsh ₁ , Julie C Fitzgerald ₁ , Michael A Keenaghan ₁ , Hussam Alharash ₁ , Sule Doymaz ₁ , Katharine N Clouser ₁ , John S Giuliano ₁ , Anjali Gupta ₁ , Robert M Parker ₁ , Aline B Maddux ₁ , Vinod Havalad ₁ , Stacy Ramsingh ₁ , Hulya Bukulmez ₁ , Tamara T Bradford ₁ , Lincoln S Smith ₁ , Mark W Tenforde ₁ , Christopher L Carroll ₁ , Becky J Riggs ₁ , Shira J Gertz ₁ , Ariel Daube ₁ , Amanda Lansell ₁ , Alvaro Coronado Munoz ₁ , Charlotte V Hobbs ₁ , Kimberly L Marohn ₁ , Natasha B Halasa ₁ , Manish M Patel ₁ , Adrienne G Randolph ₁ , ,

Affiliation

From the COVID-19 Response, Centers for Disease Control and Prevention (L.R.F., E.B.R., J.P.C., M.W.T., M.M.P.), and the Division of Critical Care Medicine, Department of Pediatrics (K.M.T.), the Department of Pediatrics, Division of Infectious Diseases (P.J.), and the Department of Pediatrics, Division of Cardiology (M.E.O.), Emory University School of Medicine, Atlanta; Public Health Service Commissioned Corps, Rockville (L.R.F., E.B.R., M.M.P.), and the Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (B.J.R.) - both in Maryland; the Department of Pediatrics, Division of Pediatric Critical Care, Bristol-Myers Squibb Children's Hospital, Robert Wood Johnson Medical School, Rutgers University (S.M. Horwitz), the Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Rutgers Robert Wood Johnson Medical School (L.C.K.), New Brunswick, the Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of New Jersey, Newark Beth Israel, Newark (R.F.W.), the Division of Hospital Medicine, Department of Pediatrics, Hackensack University Medical Center, Hackensack (K.N.C.), and the Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston (S.J.G.) - all in New Jersey; the Department of Anesthesiology, Critical Care and Pain Medicine (M.M.N., A.G.R.), the Division of Immunology (M.B.F.S.), and the Department of Cardiology (J.W.N.), Boston Children's Hospital, and the Departments of Pediatrics (M.B.F.S., J.W.N., A.G.R.) and Anaesthesia (A.G.R.), Harvard Medical School, Boston, and the Department of Pediatrics, Pediatric Critical Care, Baystate Medical Center, Springfield (K.L.M.) - both in Massachusetts; the Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University, Detroit (S.M. Heidemann, A.A.M.); the Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla (A.R.S., S.L.), Pediatric Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at the Mount Sinai Kravis Children's Hospital (S.P.Z., J.G.), the Division of Pediatric Infectious Diseases, Departments of Pediatrics and Microbiology, New York University Grossman School of Medicine (A.J.R.), Pediatric Critical Care, New York City Health and Hospitals, Kings County Hospital (M.A.K., H.A.), the Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University (S.D.), and the Department of Pediatrics, Division of Pediatric Critical Care, Maimonides Children's Hospital (A.D.), New York - all in New York; the Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.C.F.); the Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven (J.S.G., A.G.), and the Division of Critical Care, Connecticut Children's, Hartford (R.M.P., C.L.C.) - both in Connecticut; the Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (A.B.M.); the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Advocate Children's Hospital, Chicago (V.H., S.R.); the Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University (H.B.), and the Division of Pediatric Hospital Medicine, Rainbow Babies and Children's Hospital (A.L.), Cleveland; the Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans (T.T.B.); the Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington, Seattle (L.S.S.); the Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston (A.C.M.); the Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson (C.V.H.); and the Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville (N.B.H.).

Background

Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

Methods

We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.

Results

We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).

Conclusions

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)

中文翻译：

美国儿童和青少年的多系统炎症综合征。

背景

鉴于该综合征的临床和公共卫生影响，了解儿童多系统炎症综合征 (MIS-C) 的流行病学和临床过程及其与 2019 年冠状病毒病 (Covid-19) 的时间关联非常重要。

方法

我们于 2020 年 3 月 15 日至 5 月 20 日在美国各地的儿科健康中心对 MIS-C 进行了针对性监测。病例定义包括六个标准：导致住院的严重疾病、年龄小于 21 岁、持续至少 24 小时的发烧、炎症的实验室证据、多系统器官受累以及感染严重急性呼吸综合征冠状病毒 2 的证据(SARS-CoV-2) 基于逆转录酶聚合酶链反应 (RT-PCR)、抗体测试或在过去一个月内接触过 Covid-19 患者。临床医生将数据抽象为标准化表格。

结果

我们报告了 26 个州的 186 名 MIS-C 患者。中位年龄为 8.3 岁，115 名患者（62%）为男性，135 名（73%）既往健康，131 名（70%）通过 RT-PCR 或抗体检测对 SARS-CoV-2 呈阳性，164 名（ 88%) 在 2020 年 4 月 16 日之后住院。器官系统受累包括 171 名患者 (92%) 的胃肠系统、149 名患者 (80%) 的心血管、142 名 (76%) 的血液系统、137 名 (74%) 的皮肤粘膜, 和呼吸系统 131 (70%)。住院时间中位数为 7 天（四分位距，4 至 10）；148名患者（80%）接受了重症监护，37名（20%）接受了机械通气，90名（48%）接受了血管活性药物支持，4名（2%）死亡。15 名患者（8%）记录了冠状动脉瘤（z 评分 ≥2.5），74 名（40%）记录了川崎病样特征。大多数患者 (171 [92%]) 至少有四种指示炎症的生物标志物升高。免疫调节疗法的使用很常见：144 例（77%）使用静脉内免疫球蛋白，91 例（49%）使用糖皮质激素，38 例（20%）使用白细胞介素 6 或 1RA 抑制剂。