Covid-19 ilişkili pediatrik multisistem inflamatuar hastalık (PIMS) tanılı olgularımızın değerlendirilmesi
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Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
PIMS, akut SARS-CoV2 enfeksiyonundan genellikle 2-6 hafta sonra görülen; dirençli ateş ve birden fazla organ sistemi etkilenimi (mukokutanöz, gastrointestinal, hematolojik, kardiyovasküler, nörolojik, pulmoner) ile seyreden inflamatuar bir hastalıktır. Bu çalışmanın amacı kliniğimizde PIMS tanısı ile izlenen olguların demografik, klinik, laboratuvar özelliklerini ve tedavi yöntemlerini incelemektir. Bu amaçla Mart 2020 ile Mart 2022 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Hastanesi Çocuk Pandemi Servisi, Çocuk Genel Servisi ve Çocuk Kardiyoloji Servisi'nde PIMS tanısı ile izlenen olguların dosyaları ve epikriz formları geriye dönük olarak incelendi. Hasta dosyalarından cinsiyet, yaş, vücut kitle indeksi, klinik öykü, fizik muayene bulguları, laboratuvar bulguları ve tedavi rejimleri kaydedildi. İstatistiksel analizi SPSS 26.0 programı (lisans numarası:10240642) ile yapıldı. Çalışmada Student-t testi ve Pearson Ki-kare testi kullanıldı. PIMS tanısı alan olgularımız, CDC (Hastalık Kontrol ve Önleme Merkezleri)’nin belirlediği tanı kriterlerine sahipti. Hastalığın tanısal algoritma ve tedavi algoritması için Amerikan Romatoloji Koleji’nin yayınladığı kılavuzardan yararlanıldı. Çalışmaya 8 kız (%25), 24 erkek (%75) olmak üzere toplam 32 hasta alındı. Olguların yaş ortalaması 8,37±4,32 yıldı. Olgularımızda en sık hematolojik sistem tutulumu olduğunu saptadık (%84,3). Mukokutanöz tutulumu olan olgularımızın yaş ortalamasının anlamlı derecede daha düşük olduğunu gözlemledik. Olgularımızdaki laboratuvar bulgularından hiperfibrinojenemi ve hipoalbuminemi ile kardiyovasküler sistem tutulumu ve mitral yetersizlik arasında anlamlı bir ilişki mevcuttu. Hiperfibrinojenemi ve hiponatremi ile ?3 sistem tutulumu arasında anlamlı bir ilişki görüldü. Sol ventrikül sistolik disfonksiyonu olan olgularda CRP, MPV ortalaması daha yüksek; trombosit sayısı, albumin ve sodyum ortalaması daha düşük saptandı. Üç ve daha fazla sistem tutulumu olan olgularda CRP, ferritin, fibrinojen, lökosit sayısı, mutlak nötrofil sayısı ve troponin-ı ortalaması daha yüksek; albumin ve sodyum ortalaması daha düşük saptandı. Hastanede 7 günden fazla kalan olguların albumin ortalaması daha düşük; nötrofil/lenfosit sayısı ortalaması daha yüksek bulundu. Olguların hastanede kaldığı gün ortalaması ile lenfopeni ve MPV yüksekliği arasında anlamlı bir ilişki görüldü. Sonuç olarak PIMS tanılı olgularımızın demografik özellikleri ile klinik ve laboratuvar bulguları literatür verileri ile uyumlu bulunmuştur. Buna ek olarak, olgulardaki çeşitli laboratuvar bulguları ile sistem tutulum bulguları arasında anlamlı ilişkiler kaydedilmiştir. Çalışmamızdaki olguların büyük bir kısmının hafif PIMS sınıfında olması ve olgu sayımızın az olması nedeniyle kötü prognoz ve mortalite üzerine ayrıntılı değerlendirme yapılamasa da; hastanede kalım süresi ve ?3 organ sistemi etkilenimine yönelik incelemeler yapılmıştır. PIMS olgularında özellikle uzun dönem takipleri ve prognostik belirteçleri belirlemeye yönelik geniş serili ve ileriye dönük çalışmalara ihtiyaç vardır.
PIMS is usually seen 2-6 weeks after acute SARS-CoV2 infection; It is an inflammatory disease with refractory fever and multi-organ system involvement (mucocutaneous, gastrointestinal, hematological, cardiovascular, neurological, pulmonary). The aim of this study is to examine the demographic, clinical, laboratory characteristics and treatment methods of the cases followed up with the diagnosis of PIMS in our clinic. For this purpose, the files and epicrisis forms of the cases followed up with the diagnosis of PIMS in the Pediatric Pandemic Service, Pediatric General Service and Pediatric Cardiology Service of Trakya University Medical Faculty Hospital between March 2020 and March 2022 were retrospectively reviewed. Gender, age, body mass index, clinical history, physical examination findings, laboratory findings and treatment regimens were recorded from patient files. Statistical analysis was performed using SPSS 26.0 program (license number:10240642). Student-t test and Pearson Chi-square test were used in the study. Our cases diagnosed with PIMS had the diagnostic criteria determined by the CDC (Centers for Disease Control and Prevention). Guidelines published by the American College of Rheumatology were used for the diagnostic algorithm and treatment algorithm of the disease. A total of 32 patients, 8 girls (25%) and 24 boys (75%), were included in the study. The mean age of the cases was 8.37±4.32 years. We found that the most common system involvement in our cases was the hematological system (%84.3). We observed that the mean age of our cases with mucocutaneous involvement was significantly lower. There was a significant correlation between hyperfibrinogenemia and hypoalbuminemia, among the laboratory findings in our cases, and cardiovascular system involvement and mitral regurgitation. There was a significant correlation between hyperfibrinogenemia and hyponatremia and ?3 system involvement. In cases with left ventricular systolic dysfunction, the mean level of CRP and MPV was higher; mean platelet count, albumin and sodium were found to be lower. Mean level of CRP, ferritin, fibrinogen, leukocyte count, absolute neutrophil count and troponin-I were higher in cases with three or more system involvements; mean level of albumin and sodium were found to be lower. The mean level albumin level of the patients who stayed in the hospital for more than 7 days was lower; mean neutrophil/lymphocyte count was higher. There was a significant correlation between the mean days of hospitalization and lymphopenia and MPV elevation. As a result, the demographic characteristics and clinical and laboratory findings of our cases diagnosed with PIMS were found to be compatible with the literature data. In addition, significant correlations were noted between various laboratory findings and system involvement findings in the cases. Although most of the cases in our study were in the mild PIMS class and the number of our cases was low, a detailed evaluation on poor prognosis and mortality could not be made; Investigations were made for the length of hospital stay and ?3 organ system effects. In PIMS cases, there is a need for long-term follow-up and prospective studies with large series to determine prognostic markers.
PIMS is usually seen 2-6 weeks after acute SARS-CoV2 infection; It is an inflammatory disease with refractory fever and multi-organ system involvement (mucocutaneous, gastrointestinal, hematological, cardiovascular, neurological, pulmonary). The aim of this study is to examine the demographic, clinical, laboratory characteristics and treatment methods of the cases followed up with the diagnosis of PIMS in our clinic. For this purpose, the files and epicrisis forms of the cases followed up with the diagnosis of PIMS in the Pediatric Pandemic Service, Pediatric General Service and Pediatric Cardiology Service of Trakya University Medical Faculty Hospital between March 2020 and March 2022 were retrospectively reviewed. Gender, age, body mass index, clinical history, physical examination findings, laboratory findings and treatment regimens were recorded from patient files. Statistical analysis was performed using SPSS 26.0 program (license number:10240642). Student-t test and Pearson Chi-square test were used in the study. Our cases diagnosed with PIMS had the diagnostic criteria determined by the CDC (Centers for Disease Control and Prevention). Guidelines published by the American College of Rheumatology were used for the diagnostic algorithm and treatment algorithm of the disease. A total of 32 patients, 8 girls (25%) and 24 boys (75%), were included in the study. The mean age of the cases was 8.37±4.32 years. We found that the most common system involvement in our cases was the hematological system (%84.3). We observed that the mean age of our cases with mucocutaneous involvement was significantly lower. There was a significant correlation between hyperfibrinogenemia and hypoalbuminemia, among the laboratory findings in our cases, and cardiovascular system involvement and mitral regurgitation. There was a significant correlation between hyperfibrinogenemia and hyponatremia and ?3 system involvement. In cases with left ventricular systolic dysfunction, the mean level of CRP and MPV was higher; mean platelet count, albumin and sodium were found to be lower. Mean level of CRP, ferritin, fibrinogen, leukocyte count, absolute neutrophil count and troponin-I were higher in cases with three or more system involvements; mean level of albumin and sodium were found to be lower. The mean level albumin level of the patients who stayed in the hospital for more than 7 days was lower; mean neutrophil/lymphocyte count was higher. There was a significant correlation between the mean days of hospitalization and lymphopenia and MPV elevation. As a result, the demographic characteristics and clinical and laboratory findings of our cases diagnosed with PIMS were found to be compatible with the literature data. In addition, significant correlations were noted between various laboratory findings and system involvement findings in the cases. Although most of the cases in our study were in the mild PIMS class and the number of our cases was low, a detailed evaluation on poor prognosis and mortality could not be made; Investigations were made for the length of hospital stay and ?3 organ system effects. In PIMS cases, there is a need for long-term follow-up and prospective studies with large series to determine prognostic markers.
Açıklama
Anahtar Kelimeler
Koronavirüs hastalığı 2019, Covıd-19, Multisistem inflamatuar sendrom çocuklarda, Pediatrik multisistem inflamatuar sendrom, Çocuk, Coronavirus disease 2019, Covid-19, Multisystem inflammatory syndrome in children, Pediatric multisystem inflammatory syndrome, Child
