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Laboratory features in children with pediatric inflammatory multisystem syndrome (PIMS) and other invasive febrile diseases
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Introdução: A COVID-19 não parece afetar as crianças de forma tão grave como os adultos, contudo, tem sido descrita uma entidade nova e emergente chamada síndrome inflamatório multissistémico pediátrico (PIMS). As crianças com PIMS frequentemente apresentam-se gravemente doentes com necessidade de cuidados intensivos. A fisiopatologia e o padrão laboratorial do PIMS não são ainda completamente compreendidos, o que dificulta o diagnóstico diferencial com outras doenças febris invasivas.
Objetivos: O objetivo do estudo é compreender melhor o padrão analítico do PIMS e diferencia-lo de outras doenças febris invasivas, de forma a otimizar o diagnóstico desta nova entidade.
Métodos: Realizou-se um estudo prospetivo numa unidade de cuidados intensivos pediátricos (UCIPED) num hospital universitário. Pediu-se o mesmo painel analítico para ambos os grupos: PCR, PCT, VS, IL6, NT-proBNP, troponina T, ferritina, aPTT, PT, fibrinogénio e contagem de linfócitos. A análise laboratorial foi realizada duas vezes, à admissão e às 48 horas. O valor mais alto de cada variável foi selecionado, exceto a contagem linfocitária para a qual selecionamos o valor mais baixo.
Resultados: Incluíram-se quarenta e um doentes no estudo, vinte e quatro no grupo PIMS e dezassete no grupo não-PIMS. O estudo demonstrou que o PIMS afeta mais crianças mais velhas e adolescentes, com uma mediana de idade de 12 anos. A linfopenia observou-se em todos os doentes PIMS. O NT-proBNP e a Troponina T foram significativamente superiores no grupo PIMS, assim como a PCR, VS e fibrinogénio. O valor de IL6 foi semelhante nos dois grupos (p-value=0.745).
Conclusão: Os doentes com PIMS apresentam um perfil laboratorial com aumento das enzimas cardíacas e marcadores inflamatórios. A linfopenia foi um achado transversal a todos os doentes do grupo PIMS. A IL6 deve ser interpretada cautelosamente na decisãoterapêutica nos doentes PIMS, uma vez que não é diferente nos doentes com outras doenças febris invasivas.
Background: COVID-19 does not seem to affect children as much as adults, however, a new and emergent entity has been described named pediatric inflammatory multisystem syndrome (PIMS). Children with PIMS are often critically ill and require intensive care. The pathophysiology and laboratory features of this new condition are not yet fully understood, which makes it difficult to make a differential diagnosis with other invasive febrile diseases. Objectives: This investigation aims to compare the laboratory features between children with PIMS and children with other invasive febrile diseases, to better understand the laboratory panel in PIMS and to optimize the diagnosis of this new entity. Methods: A single-center prospective study was conducted in a pediatric intensive care unit (PICU) at a university-affiliated hospital. The same laboratory panel was performed for both groups: CRP, PCT, ESR, IL6, NT-proBNP, troponin T, ferritin, aPTT, PT, fibrinogen, and lymphocyte count. The laboratory tests were performed twice, at admission and 48 hours later. The highest value was selected for all variables, except for the lymphocytes, for which we selected the lowest value. Results: Forty-one patients were enrolled, twenty-four in the PIMS group and seventeen in the non-PIMS group. We found that PIMS seems to affect older children and adolescents with a median age of 12 years old. Lymphopenia was present in every patient in the PIMS group. NT-proBNP and Troponin T were significantly higher in the PIMS group, as well as CRP, ESR and fibrinogen. The IL-6 values were similar between the two groups (p-value=0.745). Conclusions: Patients with PIMS have a laboratory profile with high cardiac and inflammatory markers. Lymphopenia was a universal feature in the PIMS group. IL-6must be interpreted cautiously when making therapeutic decisions in PIMS patients as it is not different from patients with other febrile illnesses
Background: COVID-19 does not seem to affect children as much as adults, however, a new and emergent entity has been described named pediatric inflammatory multisystem syndrome (PIMS). Children with PIMS are often critically ill and require intensive care. The pathophysiology and laboratory features of this new condition are not yet fully understood, which makes it difficult to make a differential diagnosis with other invasive febrile diseases. Objectives: This investigation aims to compare the laboratory features between children with PIMS and children with other invasive febrile diseases, to better understand the laboratory panel in PIMS and to optimize the diagnosis of this new entity. Methods: A single-center prospective study was conducted in a pediatric intensive care unit (PICU) at a university-affiliated hospital. The same laboratory panel was performed for both groups: CRP, PCT, ESR, IL6, NT-proBNP, troponin T, ferritin, aPTT, PT, fibrinogen, and lymphocyte count. The laboratory tests were performed twice, at admission and 48 hours later. The highest value was selected for all variables, except for the lymphocytes, for which we selected the lowest value. Results: Forty-one patients were enrolled, twenty-four in the PIMS group and seventeen in the non-PIMS group. We found that PIMS seems to affect older children and adolescents with a median age of 12 years old. Lymphopenia was present in every patient in the PIMS group. NT-proBNP and Troponin T were significantly higher in the PIMS group, as well as CRP, ESR and fibrinogen. The IL-6 values were similar between the two groups (p-value=0.745). Conclusions: Patients with PIMS have a laboratory profile with high cardiac and inflammatory markers. Lymphopenia was a universal feature in the PIMS group. IL-6must be interpreted cautiously when making therapeutic decisions in PIMS patients as it is not different from patients with other febrile illnesses
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Linfopenia Criança gravemente doente Síndrome inflamatório multissistémico pediátrico (PIMS) Multisystemic inflammatory syndrome in children (MIS-C) Sépsis Hiperinflamação Pediatria