The impact of the SARS-CoV-2 link on outcomes in hospitalized children with PIMS across Canada

Since April 2020, various international reports have identified a rare but dangerous multisystem inflammatory disease in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Some of the more common symptoms associated with this disease included fever, hyper-inflammation, a Kawasaki disease (KD)-like presentation, as well as a shock-like condition that overlaps with toxic shock syndrome (TSS ). Taken together, this condition has been termed pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C).

Study: Epidemiology and role of the link between SARS-CoV-2 and pediatric inflammatory multisystem syndrome (PIMS): a national prospective study from the Canadian Pediatric Surveillance Program. Image Credit: Africa Studio / Shutterstock.com

About the study

The Canadian Pediatric Surveillance Program (CPSP) is managed by the Canadian Pediatric Society and the Public Health Agency of Canada (PHAC) and collects data on rare diseases and conditions with high morbidity and mortality rates. In March 2020, CPSP initiated a nationwide SARS-CoV-2 Acute Infection Study, which was quickly adapted to incorporate PIMS-TS surveillance after reports of this associated post-infectious hyperinflammatory syndrome were published. to SARS-CoV-2 infection.

In a recent study published on the medRxiv* preprint server, researchers are using CPSP data to analyze the clinical effects and implications of SARS-CoV-2 infection in children hospitalized with potential PIMS-TS.

Here, the CPSP established a surveillance case definition of suspected pediatric inflammatory multisystem syndrome, which included persistent fever, elevated inflammatory markers, features of KD and/or TSS. In particular, no alternative diagnosis was provided for the patients included in this study.

Demographic, clinical, laboratory, and treatment information about each patient was also included. With standardized body surface area measurements, coronary artery abnormalities were identified by lesion Z-scores.

Study results

The CPSP PIMS study included 493 patients, of whom 406 met the criteria for the PIMS study. Of these patients, 202 children were diagnosed with PIMS and were ultimately included in the final analysis.

Nearly 67% of study participants had close contact with a COVID-19 positive patient, while 52% were confirmed positive for COVID-19 using reverse transcription polymerase chain reaction testing ( RT-PCR) and 48.0% had a positive result. serology results. Nearly 28% of PCR-positive patients tested positive during their hospital stay, while the remaining patients tested positive for COVID-19 at a median of 4.6 weeks before hospital admission.

The median age of children hospitalized for PIMS was 5.4 years, with more than 60% of pediatric hospitalized patients being male. Although most children were healthy prior to their diagnosis of PID, 16.7% reported pre-existing comorbidity including asthma, neurological disorders and obesity in 5.9%, 3% and 3% of patients, respectively.

The median cumulative fever period in all PIMS patients was six days. In addition to fever, gastrointestinal symptoms were reported by 76.8% of children. Other symptoms, including rash, bilateral nonexudative conjunctivitis, and discomfort around the mouth, were reported in 70.9%, 704%, and 64.5% of patients, respectively.

COVID-19 positive patients were more likely to experience gastrointestinal symptoms, as well as shock and hypotension. Comparatively, patients who were negative for COVID-19 upon admission to hospital were more likely to have features of KD such as alterations around the mouth and peripheral extremities.

About 49% of PIMS patients who underwent echocardiograms had cardiac involvement. Additionally, coronary artery abnormalities were present in nearly 27% of patients, followed by cardiac function disorders identified in 18.1% of patients, with a median minimum ejection fraction of 45%.

Children under one year of age were more often diagnosed with coronary artery abnormalities with Z scores greater than 2.5. In addition, children aged 6 to 17 had lower heart function than those of younger ages.

Serum troponin levels increased in 44% of those tested, with a median peak of 13 ng/L. COVID-19 positive patients were more likely to have lower heart function and higher troponin levels than COVID-19 negative patients. No difference in coronary artery damage was reported.

Consequences

Although PIMS is rare, it is a serious adverse reaction associated with SARS-CoV-2 infection in children, with nearly one in three hospitalized children requiring admission to the ward. intensive care unit (ICU). Children aged six and over, as well as those infected with SARS-CoV-2, are at risk of hospitalization in ICUs.

Taken together, the results of the current study provide important information that can be used to support widespread vaccination of children against COVID-19. Additionally, the results of the study may help to better identify the epidemiology of PIMS in Canada, as well as provide guidance on its treatment.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

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