Cardiovascular involvement in multisystem inflammatory syndrome in children and midterm follow-up from a pediatric tertiary center in India.

Poovazhagi Varadarajan, Ritchie Sharon Solomon, Seenivasan Subramani, Ramesh Subramanian, Gomathy Srividya, Elilarasi Raghunathan
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Abstract

Background: In multisystem inflammatory syndrome in children (MIS-C) with coronavirus disease 2019, there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes. We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.

Aim: To determine association between cardiovascular abnormalities and clinical and laboratory parameters. To study the time-line for resolution of various abnormalities.

Methods: In this prospective study done in a tertiary care hospital, 270 were recruited from June 2020 to January 2022. Baseline demographic data and clinical presentation were recorded. Laboratory parameters and echocardiography were done at admission. Follow-up was done at 2 weeks, 3 months, 6 months and 1 year after diagnosis. Descriptive statistics were used for parametric and non-parametric data. Risk factors were identified by multivariate regression analysis.

Results: The 211 (78.2%) had cardiac involvement and 102 needed intensive care unit (ICU) admission. Cardiovascular abnormalities observed were shock 123 (45.6%), coronary dilatation 28 (10.4%), coronary aneurysm 77 (28.5%), left ventricular (LV) dysfunction 78 (29.3%), mitral regurgitation (MR) 77 (28.5%) and pericardial effusion 98 (36.3%). Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7% and 0.9% respectively. Multivariate regression analysis revealed breathlessness [odds ratio (OR) = 3.91, 95%CI: 1.25-12.21, P = 0.019] and hi-flow nasal cannula (HFNC) support (OR = 8.5, 95%CI: 1.06-68.38, P = 0.044) as predictors of cardiovascular involvement. Higher mean age (OR = 1.16, 95%CI: 1.02-1.32, P = 0.026), breathlessness (OR = 4.99, 95%CI: 2.05-12.20, P < 0.001), gallop (OR = 4.45, 95%CI: 0.41-2.52, P = 0.016), MR (OR = 3.61, 95%CI: 1.53-8.53, P = 0.004) and invasive ventilation (OR = 4.01, 95%CI: 1.28-12.58, P = 0.017) were predictive of LV dysfunction. Altered sensorium (OR = 4.96, 95%CI: 2.23-11.02, P < 0.001), headache (OR = 6.61, 95%CI: 1.46-29.92, P = 0.014), HFNC (OR = 7.03, 95%CI: 2.04-24.29, P = 0.002), non-rebreathing mask usage (OR = 21.13, 95%CI: 9.00-49.61, P < 0.001) and invasive ventilation (OR = 5.64, 95%CI: 1.42-22.45, P = 0.014) were risk factors for shock. Anemia was a risk factor for coronary involvement (OR = 3.09, 95%CI: 1.79- 5.34, P < 0.001).

Conclusion: Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management. Although shock resolved quickly, resolution of ventricular function and coronary abnormalities were slower, and hence warrants a structured long-term follow-up protocol.

印度一家儿科三级中心的儿童多系统炎症综合征的心血管累及及中期随访。
背景:在2019冠状病毒病儿童多系统炎症综合征(MIS-C)中,缺乏来自低收入和中等收入国家的心血管累及及其纵向结局的数据。我们计划评估患有MIS-C的儿童心血管疾病的模式及其中期结局。目的:探讨心血管异常与临床及实验室参数的关系。研究解决各种异常的时间线。方法:这项前瞻性研究于2020年6月至2022年1月在一家三级保健医院进行,招募了270人。记录基线人口统计数据和临床表现。入院时完成实验室参数及超声心动图检查。分别于诊断后2周、3个月、6个月和1年随访。参数和非参数数据采用描述性统计。多因素回归分析确定危险因素。结果:211例(78.2%)有心脏受累,102例需要重症监护病房(ICU)治疗。心血管异常包括休克123例(45.6%),冠状动脉扩张28例(10.4%),冠状动脉瘤77例(28.5%),左心室功能障碍78例(29.3%),二尖瓣反流77例(28.5%),心包积液98例(36.3%)。随访2周和1年冠脉动脉瘤/扩张分别为25.7%和0.9%。多因素回归分析显示呼吸困难[比值比(OR) = 3.91, 95%CI: 1.25-12.21, P = 0.019]和高流量鼻插管(HFNC)支持(OR = 8.5, 95%CI: 1.06-68.38, P = 0.044)是心血管受累的预测因素。较高的平均年龄(OR = 1.16, 95%CI: 1.02-1.32, P = 0.026)、呼吸困难(OR = 4.99, 95%CI: 2.05-12.20, P < 0.001)、疾驰(OR = 4.45, 95%CI: 0.41-2.52, P = 0.016)、MR (OR = 3.61, 95%CI: 1.53-8.53, P = 0.004)和有创通气(OR = 4.01, 95%CI: 1.28-12.58, P = 0.017)是左室功能障碍的预测指标。感觉改变(OR = 4.96, 95%CI: 2.23 ~ 11.02, P < 0.001)、头痛(OR = 6.61, 95%CI: 1.46 ~ 29.92, P = 0.014)、HFNC (OR = 7.03, 95%CI: 2.04 ~ 24.29, P = 0.002)、使用非再呼吸口罩(OR = 21.13, 95%CI: 9.00 ~ 49.61, P < 0.001)和有创通气(OR = 5.64, 95%CI: 1.42 ~ 22.45, P = 0.014)是发生休克的危险因素。贫血是冠脉受累的危险因素(OR = 3.09, 95%CI: 1.79 ~ 5.34, P < 0.001)。结论:大量MIS-C患儿有心血管累及,有助于提高ICU的管理水平。虽然休克很快消退,但心室功能和冠状动脉异常的消退较慢,因此需要一个结构化的长期随访方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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