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Meta-Analysis
. 2021 Jan:102:319-326.
doi: 10.1016/j.ijid.2020.11.145. Epub 2020 Nov 14.

Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis

Hua Zou  1 , Juan Lu  2 , Jingjing Liu  3 , Josiah Hiu-Yuen Wong  4 , Si Cheng  5 , Qiuhong Li  1 , Yan Shen  1 , Chunli Li  6 , Xiaojiong Jia  7
Affiliations
Meta-Analysis

Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis

Hua Zou et al. Int J Infect Dis. 2021 Jan.

Abstract

Objectives: There was an outbreak of pediatric multisystem inflammation syndrome (PMIS) was observed in multiple countries recently, and this syndrome was suspected to be associated with SARS-CoV-2 infection. At present, there is still no standardized diagnostic criteria and treatment regimen for PMIS, while the etiology and pathogenesis still remain unclear.

Methods: We performed a systematic review on PubMed and Embase from the time of inception to June 24th 2020 in order to find relevant cases.

Results: There are seven studies included, and 80% of patients suffered persistent fever and 90% appeared gastrointestinal symptoms. IgG antibody against SARS-CoV-2 was positive on 81% of patients, while 37% of the patients were nucleic acid positive. C-reactive protein, IL-6 and PCT were elevated and intravenous immunoglobulin was a routine treatment for PMIS. There were more than half of patients required inotropic supports and mechanical ventilation were applied to 33% of patients. The median length of hospital stay was 10.66 days and 74% had admitted to accept intensive care.

Conclusions: Our study documented three common types of PMIS clinical presentation: persistent fever and gastrointestinal symptoms, shocked with heart dysfunction and Kawasaki disease-like syndrome. PMIS patients proved with a marked inflammatory state were possibly associated with SARS-CoV-2 infection.

Keywords: COVID-19; Pediatric Multi-system Inflammatory Syndrome; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process.
Fig. 2
Fig. 2
Pooled clinical characteristics of PMIS. A) Gastrointestinal symptoms B) Febrile and inflammatory C) shock D) left ventricular dysfunction E) KD F) respiratory symptom.
Fig. 3
Fig. 3
Pooled risk factors of PMIS. A) Contact with viral B) Onset of Kawa-COVID-19 to hospitalization C) Nucleic acid positive of SARS Cov-2 D) lgG of SARS Cov-2.
Fig. 4
Fig. 4
Pooled laboratory results of PMIS. A) Lymphocyte B) Platelet C) CRP D) IL-6 E) PCT F) Albumin G) Troponin H) NT-proBNP I) D-dimer.
Fig. 5
Fig. 5
Pooled treatment of PMIS. A) Intravenous immunoglobulin B) Anticoagulation C) Inotropic support D) Intubation E) Corticosteroids.
Fig. 6
Fig. 6
Pooled outcome of PMIS. A) Length of hospital stay B) Admitted to intensive care unit C) Dilatation of the coronary arteries
See this image and copyright information in PMC

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