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Cardiovascular Spectrum and Cardiac Biomarkers in Pediatric Inflammatory Multisystem Syndrome with Kawasaki-Like Disease - Our Experience During the COVID-19 Pandemic in the West Part of Romania

Gabriela Doros
Gabriela Doros
, 
Mihaela Bataneant
Mihaela Bataneant
, 
Delia Mihailov
Delia Mihailov
, 
Anca Popoiu
Anca Popoiu
, 
Ramona Stroescu
Ramona Stroescu
, 
Ruxandra Steflea
Ruxandra Steflea
, 
Andreea Vartop
Andreea Vartop
, 
Cristiana Stolojanu
Cristiana Stolojanu
 et 
Andrada-Mara Micsescu-Olah
Andrada-Mara Micsescu-Olah
   | 05 mai 2022
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Article Category: Original Article
Publié en ligne: 05 mai 2022
Pages: 861 - 873
DOI: https://doi.org/10.47803/rjc.2020.31.4.861
Mots clés
© 2021 Gabriela Doros et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Age related cases.
Age related cases.

Figure 2

Gender distribution.
Gender distribution.

Figure 3

Patients with PIMS and Kawasaki-like clinical features (from left to right, upper and lower row: aseptic conjunctivitis, red and cracked lips, unilateral latero-cervical lymph node, rash, edema of the hands). From our personal collection.
Patients with PIMS and Kawasaki-like clinical features (from left to right, upper and lower row: aseptic conjunctivitis, red and cracked lips, unilateral latero-cervical lymph node, rash, edema of the hands). From our personal collection.

Figure 4

Clinical symptoms at admission.
Clinical symptoms at admission.

Figure 5

ECG changes during hospitalization in 6 patients.
ECG changes during hospitalization in 6 patients.

Figure 6

Cardiological involvement in Kawasaki-like from PIMS in COVID-19 Pandemic in our cohort, after admission.
Cardiological involvement in Kawasaki-like from PIMS in COVID-19 Pandemic in our cohort, after admission.

Figure 7

Echocardiography: parasternal short axis through aorta – perivascular brightness with normal coronary arteries.
Echocardiography: parasternal short axis through aorta – perivascular brightness with normal coronary arteries.

Figure 8

NT-proBNP values at admittance in our cohort.
NT-proBNP values at admittance in our cohort.

Figure 9

cTroponin T values at admission in our cohort.
cTroponin T values at admission in our cohort.

Figure 10

Troponin I values at admission.
Troponin I values at admission.

Figure 11

Interleukin IL6 at admittance.
Interleukin IL6 at admittance.

Figure 12

Soluble receptor for Interleukin IL2.
Soluble receptor for Interleukin IL2.

Diagnostic criteria for KD and incomplete KD, proposed by AHA

Kawasaki Disease (KD) Incomplete Kawasaki Disease
Fever ≥5 days + 4 from 5 criteria: Fever ≥5 days + <4 criteria of classic KD
• Bilateral aseptic conjunctivitis And CRP ≥30 mg/dl, ESR ≥40 mm/h
• Erythema and cracking lips, strawberry tongue With positive echocardiography
• Rash, erythroderma, erythema multiform like Or 3 from the following:
• Unilateral lymphadenopathy • Anemia
• Erythema and edema of the hands and feet • WBC ≥ 15.000/mm3
• Thrombocytes ≥450.000/mm3 after 7 days
• Albumin ≤3 g/dl
• ALT elevated
• Urine ≥10 WBC/hpf

Cardiac biomarkers, IL6 and Soluble receptor IL2 in our cohort

Patient nr. NT-proBNPpg/mlNV depending on age cTroponin TNV<14 pg/ml cTroponin INV<34.2 pg/ml CK MBNV<5 ng/ml IL6NV<7 pg/ml Soluble receptorIL2NV 158–623 kU/l
1. 339.4 4.59 0.6 0.49 3.06 -
2. 468.8 8.39 - - 38.41 -
3. 3101 34 36.2 2.15 162.3 11000
4. 131 30.31 19.9 1.41 - -
5. 124 40.49 27.4 - 4.27 -
6. 27408 92.36 190.7 <0.18 44.44 6599
7. 7188 9.24 7.4 <0.18 251.56 11383
8. 14922 81 186 - 403 -
9. 6437 64.62 147.6 0.57 51.93 4842
10. 11972 18.7 25 0.58 74 9689
11. - - - - 468275 8749
12. 11043 - 848 - 13.96 -
13. 74 4.5 3 - 12.51 1543
14. 67 <3 <0.1 - 29.04 -

Clinical features and laboratory findings in Kawasaki Disease children compared with PIMS patients

Clinical feature/Lab Kawasaki Disease PIMS
Age of child at presentation <5 years old 7–8 years old
Gastro-intestinal symptoms +/− +++
Cardiac dysfunction + ++
Coagulopathy +/− ++
Macrophage activation syndrome (MAS) +/− ++
Shock +/− ++
CRP ++ ++++
Ferritin +/− ++
DDimers + ++
Cardiac biomarkers: NT-proBNP, Troponin I + ++
Thrombocytopenia Rare ++

Laboratory investigations related with treatment

Patient CRP < 5 mg/dl Ferritin 20–200 ng/ml D-dimer < 250 ng/ml Fibrinogen 200–400 mg/dl IgG Antibody against SARS-CoV-2 < 33 BAU IVIG Steroids Anticoagulant Inotrope medication
1. 128 895 6215 633 0.13 + +
2. 78 132 3578 310 0.54 +
3. 260 792 8657 529 − + + + +
4. 17 67 209 240 0.61 + +
5. 3.43 98 278 238 60 + + +
6. 107 651 3228 279 14.4 +
7. 165.59 980 3080 148 8.4 + + +
8. 232 1870 3347 509 4.84 + + + +
9. 143 1612 409 362 76 + + +
10. 258 1314 660 162 251 + + +
11. 72.63 100000 3404 23 0,2 + + +
12. 0.6 17105 11987 107 716 + + +
13. 159 330859 69000 100 5 + +
14. 73.73 143 992 169 1420 + +

Comparison between the definitions of PIMS-TS established by RCPCH and CPSP and MIS-C defined by CDC and WHO

Organization RCPCH CPSP CDC WHO
Name PIMS-TS PIMS-TS MIS-C MIS-C
Age of child Child < 18 years < 21 years 0–19 years
Fever-duration Not specified > 3 days > 24 h > 3 days
Inflammation + + + +
Organs affected 1 or multiple Not specified, but affected ≥ 2 ≥ 2
Exclusion of other causes Must Must Must Must
Proof of the SARS-CoV-2 infection Not necessary Not necessary Necessary Necessary
eISSN:
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Langue:
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Sujets de la revue:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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