Pediatrician (St. Petersburg)Pediatrician (St. Petersburg)Педиатр2079-78502587-6252Eco-Vector33258910.17816/PED14145-59Original studiesОригинальные статьиResearch ArticleThe predictors of severe course of multisystem inflammatory syndrome associated with the new coronavirus infection COVID-19 in children: results of a retrospective-prospective multicenter studyПредикторы тяжелого течения мультисистемного воспалительного синдрома, ассоциированного с новой коронавирусной инфекцией COVID-19, у детей: результаты ретроспективно-проспективного многоцентрового исследованияAvrusinIlia S.АврусинИлья Сергеевич
Russian Federation

senior research assistant, assistant professor of the Department of Hospital Pediatrics, assistant professor of the Department of General Medical Practice

ст. лаборант медицинский, ассистент кафедры госпитальной педиатрии, ассистент кафедры общей медицинской практики

avrusin95@gmail.comAbramovaNatalia N.АбрамоваНаталья Николаевна
Russian Federation

doctor of the Intensive Care Unit

врач отделения анестезиологии и реанимации

abrnatalia@yandex.ruBelozerovKonstantin E.БелозеровКонстантин Евгеньевич
Russian Federation

postgraduate student, Department of Hospital Pediatrics

аспирант кафедры госпитальной педиатрии

biancolago@bk.ruEfremovaOlesya S.ЕфремоваОлеся Станиславовна
Russian Federation

cardiologist, assistant of the Department of Pediatrics

врач-кардиолог, ассистент кафедры педиатрии

shaguno@mail.ruBregelLyudmila V.БрегельЛюдмила Владимировна
Russian Federation

chief pediatric cardiologist of the Irkutsk Region, MD, PhD, Dr. Sci. (Med.), professor, head of the Department of Pediatrics, head, Department of Cardiology

д-р мед. наук, профессор, заведующая кафедрой педиатрии, заведующая отделением кардиологии, главный детский кардиолог Иркутской области

loudmilabregel@yandex.ruKondratievGleb V.КондратьевГлеб Валентинович
Russian Federation

pediatric oncologist, assistant professor of the Department of Oncology, Pediatric Oncology and Radiation Therapy

врач-онколог детский, ассистент кафедры онкологии, детской онкологии и лучевой терапии

spbgvk@mail.ruDondureyElena A.ДондурейЕлена Александровна
Russian Federation

chief pediatric infectious disease specialist of Saint Petersburg, MD, PhD, head, Infectious Boxed Department. ; senior lecturer

канд. мед. наук, заведующая инфекционным боксированным отделением; ст. преподаватель; главный внештатный детский инфекционист Санкт-Петербурга

dondureyelena@yandex.ruVilnitzAlla A.ВильницАлла Ароновна
Russian Federation

MD, PhD, Dr. Sci. (Med.), head, Research Department of Intensive Care of Emergency Conditions; professor, Department of Infectious Diseases in Children of AF and DPO

д-р мед. наук, заведующая научно-исследовательским отделом интенсивной терапии неотложных состояний; профессор, кафедра инфекционных заболеваний у детей ФП и ДПО

vilnitz@mail.ruKonstantinovaYulia E.КонстантиноваЮлия Евгеньевна
Russian Federation

junior research associate

мл. научн. сотр., Научно-исследовательский отдел интенсивной терапии неотложных состояний

yulia.konstantinova23@mail.ruBurtsevaTatiana E.БурцеваТатьяна Егоровна
Russian Federation

MD, PhD, Dr. Sci. (Med.), professor, Department of Pediatrics and Pediatric Surgery; head of the laboratory

д-р мед. наук, профессор кафедры педиатрии и детской хирургии; заведующая лабораторией

bourtsevat@yandex.ruVinnikovaEkaterina I.ВинниковаЕкатерина Игоревна
Russian Federation

студентка 6-го курса педиатрического факультета

студентка 6-го курса педиатрического факультета

katya.vinni99@gmail.comIsupovaEvgeniya A.ИсуповаЕвгения Алексеевна
Russian Federation

MD, PhD, rheumatologist

канд. мед. наук, врач ревматолог

miaposta@list.ruKornishinaTatiana L.КорнишинаТатьяна Леонидовна
Russian Federation

assistant professor, Department of Hospital Pediatrics

ассистент кафедры госпитальной педиатрии

tk.06@mail.ruMasalovaVera V.МасаловаВера Васильевна
Russian Federation

assistant professor, Department of Hospital Pediatrics

ассистент кафедры госпитальной педиатрии

masalova.vera@gmail.comRedkinaMaria V.РедькинаМария Васильевна
Russian Federation

pediatrician, head, consultative and diagnostic center

врач-педиатр, заведующая консультативно-диагностическим центром

redkina_masha@mail.ruSolodkovaIrina V.СолодковаИрина Владимировна
Russian Federation

MD, PhD, associate professor, Department of Hospital Pediatrics

канд. мед. наук, доцент кафедры госпитальной педиатрии

isolodkova@mail.ruKalashnikovaOlga V.КалашниковаОльга Валерьевна
Russian Federation

MD, PhD, head, Pediatric Department No. 3, assistant professor, Department of Hospital Pediatrics

канд. мед. наук, заведующая педиатрическим отделением № 3, доцент кафедры госпитальной педиатрии

koira7@yandex.ruChasnykVyacheslav G.ЧасныкВячеслав Григорьевич
Russian Federation

MD, PhD, Dr. Sci. (Med.), professor, head, Department of Hospital Pediatrics

д-р мед. наук, профессор, заведующий кафедрой госпитальной педиатрии

chasnyk@gmail.comAlexandrovichYuri S.АлександровичЮрий Станиславович
Russian Federation

MD, PhD, Dr. Sci. (Med.), professor, head, Department of Anesthesiology, Resuscitation and Emergency Pediatrics of FP and DPO, vice-rector for postgraduate and additional professional education

д-р мед. наук, профессор, заведующий кафедрой анестезиологии, реаниматологии и неотложной педиатрии ФП и ДПО, проректор по послевузовскому и дополнительному профессиональному образованию

jalex1963@mail.ruKostikMikhail M.КостикМихаил Михайлович
Russian Federation

MD, PhD, Dr. Sci. (Med.), chief pediatric specialist rheumatologist, North-Eastern Federal District; Professor, Department of Hospital Pediatrics

главный внештатный детский специалист ревматолог Северо-Западного федерального округа, д-р мед. наук, профессор кафедры госпитальной педиатрии

kost-mikhail@yandex.ruSt. Petersburg State Pediatric Medical UniversityСанкт-Петербургский государственный педиатрический медицинский университетIrkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuing Professional EducationИркутская государственная медицинская академия последипломного образования — филиал Российской медицинской академии непрерывного профессионального образованияIrkutsk State Regional Children’s Clinical Hospital, T. Kawasaki First Russian Kawasaki Disease Research CenterИркутская государственная областная детская клиническая больница, Первый Российский центр исследований болезни Кавасаки им. Т. КавасакиA.A. Smorodintsev Influenza Research InstituteНаучно-исследовательский институт гриппа им. А.А. СмородинцеваN.F. Filatov Children’s City Clinical Hospital No. 5Детская городская клиническая больница № 5 им. Н.Ф. ФилатоваChildren’s Scientific and Clinical Center of Infectious DiseasesДетский научно-клинический центр инфекционных болезнейNorth-Eastern Federal UniversityСеверо-Восточный федеральный университет им. М.К. АммосоваYakut Science Centre of Complex Medical ProblemsЯкутский научный центр комплексных медицинских проблемSt. Petersburg State Pediatric Medical UniversityСанкт-Петербургский государственный педиатрический медицинский университет1804202314145591504202315042023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-ВекторCopyright ©; 2023,2023Eco-VectorЭко-Векторhttps://journals.eco-vector.com/pediatr/article/view/332589

BACKGROUND: Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases.

AIM: To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit.

MATERIALS AND METHODS: The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of “multisystem inflammatory syndrome associated with COVID-19 in children”. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 — patients hospitalized in the intensive care unit (n = 84, 50.6%), and group 2 — patients who did not need hospitalization in the intensive care unit (n = 82, 49.4%).

RESULTS: Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed.

CONCLUSIONS: The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.

Актуальность. Мультисистемный воспалительный синдром, ассоциированный с COVID-19, у детей (МВС-Д), — это редкое, но тяжелое заболевание, при котором поражаются различные системы и органы, включая сердце, легкие, почки, мозг, кожу, глаза и органы желудочно-кишечного тракта. МВС-Д является достаточно сложным для диагностики заболеванием, так как по своей картине малоотличим от инфекционного процесса и имеет много общего с болезнью Кавасаки. Однако течение МВС-Д тяжелее, в связи с чем пациенты нуждаются в госпитализации в отделение реанимации и интенсивной терапии в половине случаев.

Цель — определить факторы, ассоциированные с тяжелым течением МВС-Д, требующим госпитализации пациентов в отделение реанимации и интенсивной терапии.

Материалы и методы. В ретроспективное исследование включено 166 пациентов (99 мальчиков, 67 девочек) в возрасте от 4 мес. до 17 лет (медиана 8,2 года) с диагнозом «мультисистемный воспалительный синдром, ассоциированный с COVID-19, у детей». Для проведения сравнительного анализа пациенты c МВС-Д были разделены на две группы: 1-я группа — пациенты, госпитализированные в отделение реанимации и интенсивной терапии (n = 84, 50,6 %), 2-я группа — пациенты, не нуждавшиеся в госпитализации в отделение реанимации и интенсивной терапии (n = 82, 49,4 %).

Результаты. Пациенты с более тяжелым течением МВС-Д были значительно старше. У них была высокая частота таких признаков, как сыпь, отеки, гепатомегалия, спленомегалия, неврологические и респираторные симптомы. Гипотензия/шок и поражение миокарда гораздо чаще встречались у пациентов с тяжелым течением МВС-Д. У этих пациентов наблюдалось значительное повышение уровня С-реактивного белка, креатинина, тропонина и Д-димера. У пациентов, госпитализированных в отделение интенсивной терапии, чаще наблюдались признаки гемофагоцитарного синдрома.

Заключение. Основными факторами, определяющими тяжесть МВС-Д, являются поражение сердечно-сосудистой системы, центральной нервной системы, наличие респираторных и гемодинамических нарушений, особенно, проявлений гемофагоцитоза.

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