Characteristics and Outcomes of Cases of Children and Adolescents With Pediatric Inflammatory Multisystem Syndrome in a Tertiary Care Center in Mexico City

  1. Ricardo Gil Guevara
  2. María de Lourdes Marroquín Yáñez
  3. Rodolfo Norberto Jiménez-Juárez
  4. Víctor Olivar Lopez
  5. Adrián Chávez Lopez
  6. Juan José Luis Sienra Monge
  7. Lourdes Maria del Carmen Jamaica Balderas
  8. Silvia Alexandra Martínez Herrera
  9. Clemen Domínguez-Barrera
  10. Julio Erdmenger Orellana
  11. Horacio Márquez González
  12. Miguel Klünder-Klünder
  13. Jaime Nieto Zermeño
  14. Mónica Villa Guillen
  15. Nadia González García
  16. Maria F. Castilla-Peon

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Abstract

Pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City.

Methods

This was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed.

Results

Seventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6–15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms ( n = 60) and cluster 2 were those with predominantly respiratory manifestations ( n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms.

Conclusion

There were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

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  1. Version published to 10.3389/fped.2022.849388
  2. Version published to 10.1101/2021.12.23.21268188v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.12.23.21268188: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The ethics review board of Federico Gómez Mexico Children’s Hospital authorized the analysis and publication of de-identified data (Reg: HIM2020-031).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Descriptive analysis was undertaken in STATAv.14.0 (StataCorp, Tx).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The role of inflammation along all spectrum of severe illness associated with SARS-CoV-2 infection should be deeply studied, including its role in myocardial disfunction since it is a frequent complication both in adults with COVID-19 and children with PIMS. (23) A limitation of this study, as in others, is the method for identification of included cases for analysis depending on spontaneous reports by treating clinicians. In the future, a prospective multicentric cohort design with clear-cut criteria for subclassification of every patient fulfilling the broad clinical criteria after SARS-CoV-2 infection would provide more information on the outcomes and possible associated factors.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.12.23.21268188v1 on medRxiv