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Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature

Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form o...

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Autores principales: Bregel, Liudmila V., Efremova, Olesya S., Kostyunin, Kirill Y., Rudenko, Natalya Y., Kozlov, Yury A., Albot, Vadim V., Knyzeva, Natalya А., Tolmacheva, Olga V., Ovanesyan, Svetlana V., Barakin, Alexander O., Pak, Ki O., Belousova, Liudmila V., Korinets, Tatyana S., Kostik, Mikhail M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10452691/
https://www.ncbi.nlm.nih.gov/pubmed/37626703
http://dx.doi.org/10.3390/biomedicines11082206
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author Bregel, Liudmila V.
Efremova, Olesya S.
Kostyunin, Kirill Y.
Rudenko, Natalya Y.
Kozlov, Yury A.
Albot, Vadim V.
Knyzeva, Natalya А.
Tolmacheva, Olga V.
Ovanesyan, Svetlana V.
Barakin, Alexander O.
Pak, Ki O.
Belousova, Liudmila V.
Korinets, Tatyana S.
Kostik, Mikhail M.
author_facet Bregel, Liudmila V.
Efremova, Olesya S.
Kostyunin, Kirill Y.
Rudenko, Natalya Y.
Kozlov, Yury A.
Albot, Vadim V.
Knyzeva, Natalya А.
Tolmacheva, Olga V.
Ovanesyan, Svetlana V.
Barakin, Alexander O.
Pak, Ki O.
Belousova, Liudmila V.
Korinets, Tatyana S.
Kostik, Mikhail M.
author_sort Bregel, Liudmila V.
collection PubMed
description Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form of the disease. Venous and arterial thrombosis in adults were identified as common causes of severe complications and deaths in new coronavirus infections. There are very few reports of thrombotic events in children with COVID-19 in the literature. Methods: We conducted a retrospective analysis of the histories of 60 patients in the Irkutsk Regional Children’s Clinical Hospital from November 2020 to November 2022 with a MIS-C diagnosis established according to WHO criteria, of which 8 (13.3%) were diagnosed with venous and/or arterial thrombosis, confirmed by laboratory and ultrasound and/or X-ray methods. Results: The average age of children with thrombosis (Me) was 7.5 years (min 4 months, max 17 years), with a M:F ratio of 3.0. Venous thrombosis was detected in six of the eight patients, including in the deep veins of the lower extremities in four. Pulmonary embolism occurred in two (one of them was fatal), and cerebral venous sinus thrombosis and thrombosis of the branches of the upper and lower vena cava were found in one patient. Extensive bilateral stroke due to thrombosis of the large cerebral arteries occurred in two patients, including one in combination with distal gangrene. Secondary thrombotic renal microangiopathy took place in three of the eight patients. Among these three, atypical HUS was diagnosed in one case. Multiple thrombosis involving the venous and arterial bed was detected in four of the eight patients. High levels of D-dimer, thrombocytopenia, increased NT-proBNP, cerebral coma, and aseptic meningitis were the events most often associated with thrombosis. All patients received immunomodulatory therapy (immunoglobulin, dexamethasone/methylprednisolone), pathogenetic therapy for multiorgan failure, anticoagulant therapy with heparin/LMWH, and acetylsalicylic acid. Biologics were used in two patients. Conclusions: The main predictors of thrombosis in children with MIS-C were increased D-dimer, thrombocytopenia, hospitalization in the ICU, and noncardiogenic pulmonary edema. Thrombosis of the deep veins of the lower extremities, large cerebral arteries, and secondary thrombotic microangiopathy was common. There was a single death (12.5% of the eight patients), associated with PE.
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spelling pubmed-104526912023-08-26 Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature Bregel, Liudmila V. Efremova, Olesya S. Kostyunin, Kirill Y. Rudenko, Natalya Y. Kozlov, Yury A. Albot, Vadim V. Knyzeva, Natalya А. Tolmacheva, Olga V. Ovanesyan, Svetlana V. Barakin, Alexander O. Pak, Ki O. Belousova, Liudmila V. Korinets, Tatyana S. Kostik, Mikhail M. Biomedicines Article Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form of the disease. Venous and arterial thrombosis in adults were identified as common causes of severe complications and deaths in new coronavirus infections. There are very few reports of thrombotic events in children with COVID-19 in the literature. Methods: We conducted a retrospective analysis of the histories of 60 patients in the Irkutsk Regional Children’s Clinical Hospital from November 2020 to November 2022 with a MIS-C diagnosis established according to WHO criteria, of which 8 (13.3%) were diagnosed with venous and/or arterial thrombosis, confirmed by laboratory and ultrasound and/or X-ray methods. Results: The average age of children with thrombosis (Me) was 7.5 years (min 4 months, max 17 years), with a M:F ratio of 3.0. Venous thrombosis was detected in six of the eight patients, including in the deep veins of the lower extremities in four. Pulmonary embolism occurred in two (one of them was fatal), and cerebral venous sinus thrombosis and thrombosis of the branches of the upper and lower vena cava were found in one patient. Extensive bilateral stroke due to thrombosis of the large cerebral arteries occurred in two patients, including one in combination with distal gangrene. Secondary thrombotic renal microangiopathy took place in three of the eight patients. Among these three, atypical HUS was diagnosed in one case. Multiple thrombosis involving the venous and arterial bed was detected in four of the eight patients. High levels of D-dimer, thrombocytopenia, increased NT-proBNP, cerebral coma, and aseptic meningitis were the events most often associated with thrombosis. All patients received immunomodulatory therapy (immunoglobulin, dexamethasone/methylprednisolone), pathogenetic therapy for multiorgan failure, anticoagulant therapy with heparin/LMWH, and acetylsalicylic acid. Biologics were used in two patients. Conclusions: The main predictors of thrombosis in children with MIS-C were increased D-dimer, thrombocytopenia, hospitalization in the ICU, and noncardiogenic pulmonary edema. Thrombosis of the deep veins of the lower extremities, large cerebral arteries, and secondary thrombotic microangiopathy was common. There was a single death (12.5% of the eight patients), associated with PE. MDPI 2023-08-06 /pmc/articles/PMC10452691/ /pubmed/37626703 http://dx.doi.org/10.3390/biomedicines11082206 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bregel, Liudmila V.
Efremova, Olesya S.
Kostyunin, Kirill Y.
Rudenko, Natalya Y.
Kozlov, Yury A.
Albot, Vadim V.
Knyzeva, Natalya А.
Tolmacheva, Olga V.
Ovanesyan, Svetlana V.
Barakin, Alexander O.
Pak, Ki O.
Belousova, Liudmila V.
Korinets, Tatyana S.
Kostik, Mikhail M.
Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title_full Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title_fullStr Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title_full_unstemmed Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title_short Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature
title_sort thrombosis in multisystem inflammatory syndrome associated with covid-19 in children: retrospective cohort study analysis and review of the literature
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10452691/
https://www.ncbi.nlm.nih.gov/pubmed/37626703
http://dx.doi.org/10.3390/biomedicines11082206
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