Mob raum raug mob hauv cov neeg mob menyuam yaus hauv tsev kho mob nrog tus mob COVID-19 Thiab Multisystem Inflammatory Syndrome nyob rau hauv cov menyuam yaus koom nrog COVID-19
Mar 04, 2022
Yog xav paub ntxiv:emily.li@wecistanche.com
Abby Basalely, Shari Gurusinghe, James Schneider, Sareen S. Shah, Linda B. Siegel3, Gabrielle Pollack, Pamela Singer, Laura J. Castellanos-Reyes, Steven Fishbane, Kenar D. Jhaveri5, Elizabeth Mitchell, Kumail Merchant, Christine Capone, Ashley M. Gefen, Julie Steinberg, thiab Christine B. Sethna
1 Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA;
2 SUNY Downstate Health Sciences University College of Medicine, Brooklyn, New York, Tebchaws USA;
3 Division of Critical Care, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA;
4 Donald thiab Barbara Zucker Tsev Kawm Ntawv Tshuaj Kho Mob ntawm Hofstra/Northwell, Hempstead, New York, USA;
5 Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine ntawm Hofstra/Northwell, Great Neck, New York, USA; thiab
6 Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
Cistanche rau kev txhim kho raum ua haujlwm
Abstract
Txoj kev tshawb no piav qhia txog qhov tshwm sim, cov yam ntxwv ntawm kev kho mob, thiab qhov tshwm sim ntawm mob hnyavraumraug mobnyob rau hauv ib pawg menyuam yaus nrog COVID-19 thiab Multisystem
Syndrome in Children (MLS-C). Peb tau ua qhov kev tshawb fawb rov qab ntawm cov neeg mob hnub nyoog 18 xyoo thiab qis dua mus rau plaub lub tsev kho mob New York hauv Northwell Health System tau ua haujlwm thaum lub sij hawm qhov siab ntawm COVID-19 kis thoob qhov txhia chaw, thaum lub Peb Hlis 9 txog Lub Yim Hli 13, 2020. Mobraumraug mobtau txhais thiab staged raws liLub raumKab mob: Txhim kho Cov Txheej Txheem Thoob Ntiaj Teb. Cov pab pawg muaj 152 tus neeg mob; 97 acute-COVID-19 thiab 55 nrog MISC cuam tshuam nrog COVID-19. Mob hnyavraumraug mobtshwm sim hauv 8 nrog mob-COVID-19 thiab hauv 10 nrog MIS-C. Mob hnyavraumraug mob, hauv cov qauv tsis hloov kho, tau cuam tshuam nrog qib qis albumin (qhov sib txawv ntawm qhov sib piv {{{0}}}.17; 95 feem pua ntawm kev ntseeg siab 0.07, 0.39) thiab ntau dua cov qe ntshav dawb (qhov txawv piv 1.11; 95 feem pua kev ntseeg siab lub sijhawm 1.04,1.2). Cov neeg mob MIS-C thiab mob hnyavraumraug mobmuaj qhov ua tau zoo ntawm systolic dysfunction ntau dua, piv rau cov tsis muaj (80 feem pua vs 49 feem pua ) .Hauv cov qauv tsis kho, cov neeg mob mob raum raug mob tau 8.4 hnub ntev mus pw hauv tsev kho mob piv rau cov neeg mob uas tsis muaj mob hnyav.raumraug mob(95 feem pua ntawm kev ntseeg siab, 4.4-6.7). Mob hnyavraumraug mobnyob rau hauv mob-COVD-19 thiab MIS-C tej zaum yuav cuam tshuam nrog kev mob thiab/los yog lub cev qhuav dej. Kev tshawb fawb ntxiv hauv cov pab pawg menyuam yaus loj dua yog xav tau kom ua tau zoo dua cov yam ntxwv muaj feem cuam tshuam rau mob raum raug mob hauv mob-COVID-19 thiab nrog MIS-C qhov tshwm sim los ntawm COVID-19.
By October 2020, the United States had >7.5 lab tus neeg mob tus kabmob coronavirus 2019 (COVID-19).1–4 Thaum pib suav tias yog mob ua pa, COVID-19 tau ua pov thawj tias yog ib qho mob ntau yam mob uas feem ntau cuam tshuam nrograumraug mob.5–8.
Mob hnyavraumraug mob(AKI) yog ib qho teeb meem tshwm sim hauv cov neeg laus uas muaj COVID-19. Cov kev tshawb fawb pib los ntawm Tuam Tshoj thiab Ltalis tau tshaj tawm AKI cov nqi siab li 29 feem pua .6,9–15 Ib txoj kev tshawb fawb tsis ntev los no los ntawm peb cov kab ke kev noj qab haus huv tau tshaj tawm tias muaj qhov tshwm sim ntau dua ntawm AKI hauv cov neeg laus (36.6 feem pua) thiab pom AKI cuam tshuam nrog kev mob thiab mortality.5,16 Cov xwm txheej no thiab kev pheej hmoo tuag tau raug txheeb xyuas hauv cov kev tshawb fawb tom ntej hauv Asmeskas.7,8
Txawm hais tias muaj ntau qhov kev tshawb fawb piav qhia txog COVID-19- cuam tshuam AKI rau cov neeg laus, muaj cov ntaub ntawv txwv tsis pub piav txog AKI hauv cov neeg mob menyuam yaus uas muaj tus kab mob COVID-19. Kev tshawb nrhiav rov qab los ntawm 238 tus neeg mob menyuam yaus tau txais mus rau Wuhan Children's Tsev Kho Mob nrog COVID-19 tau tshaj tawm 1.2 feem pua ntawm AKI.17 Cov kev tshawb fawb tsis ntev los no los ntawm Tebchaws Askiv thiab Saudi Arabia tau tshaj tawm qhov xwm txheej ntawm tus menyuam AKI ntawm 21 feem pua thiab 29. feem pua .18,19 Ib daim ntawv tshaj tawm ua ntej los ntawm ntau qhov kev tshawb fawb soj ntsuam AKI hauv 106 cov menyuam yaus mob hnyav uas muaj tus kab mob COVID{12}}, suav nrog 32 US qhov chaw, tau tshaj tawm cov ntsiab lus nthuav dav ntawm 44 feem pua (N ¼ 47).20
Cov menyuam yaus pib xav tias yuav zam dhau los ntawm qhov cuam tshuam loj ntawm COVID-19, qhov tseeb yog qhov ua rau muaj kev cuam tshuam. Thaum lub Tsib Hlis Ntuj xyoo 2020, Lub Chaw Tswj Xyuas Kab Mob thiab Tiv Thaiv tau tshaj tawm cov lus qhia txog kev noj qab haus huv rau pej xeem nrog rau cov ntsiab lus txhais rau cov kab mob ntau yam kab mob hauv cov menyuam yaus (MIS-C) cuam tshuam nrog cov kab mob COVID-19 tsis ntev los no.21 Cov menyuam yaus no nthuav tawm cov yam ntxwv zoo ib yam li cov kab mob Kawasaki lossis toxic shock syndrome.22 Cov ntawv ceeb toom tsis ntev los no ntawm cov menyuam yaus uas muaj MISC tau qhia txog qhov tshwm sim ntawm AKI hauv cov khoom siv no.22,23 Hauv kev tshuaj xyuas txog 662 tus neeg mob MIS-C, 108 (16.3 feem pua) tsim AKI; txawm li cas los xij, lub ntsiab lus ntawm AKI txawv ntawm cov chaw.23
Txawm hais tias muaj cov ntaub ntawv thaum ntxov uas AKI txhim kho hauv cov neeg mob menyuam yaus uas muaj tus mob COVID-19 thiab MIS-C, cov nqi, cov yam ntxwv kho mob cuam tshuam, thiab cov txiaj ntsig luv luv tsis zoo. Yog li, peb tsom los piav qhia txog qhov tshwm sim ntawm AKI hauv cov neeg no, txheeb xyuas cov pej xeem cuam tshuam thiab cov xwm txheej kho mob hauv cov neeg uas muaj AKI, thiab txiav txim siab txog kev koom tes ntawm AKI nrog lub sijhawm ntev ntawm kev siv tshuab cua, qhov ntev ntawm kev nyob, thiab kev tuag.
Txoj kev
Kawm tsim qauv
Kev tshuaj xyuas daim duab rov qab ntawm cov menyuam yaus nkag mus rau Northwell Health system nrog tus mob COVID-19 thiab MIS-C tau ua. Cov tsev kho mob koom nrog yog nyob rau hauv New York lub nroog cheeb tsam thiab suav nrog Cohen Children's Medical Center, lub tsev kho mob me nyuam kawm ntawv qib siab, nrog rau 3 lub tsev kho mob qib siab: South Shore Tsev Kho Mob, Staten Island University Tsev Kho Mob, thiab Lenox Hill Tsev Kho Mob. Cov ntaub ntawv txij lub Peb Hlis 9, 2020, txog rau Lub Yim Hli 13, 2020, tau sau rov qab siv cov ntaub ntawv kho mob hauv tsev kho mob hauv tsev kho mob Sunrise Clinical Manager (Allscripts, Chicago, Illinois). Txoj kev tshawb no tau pom zoo los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Northwell Health.
Peb txoj kev tshawb fawb suav nrog cov menyuam yaus hnub nyoog qis dua lossis sib npaug li 18 xyoo uas tau txais kev kho mob ntawm tus mob COVID-19 lossis MIS-C. Cov neeg mob tau raug txiav txim siab tias muaj tus mob COVID-19 yog tias, nyob rau hauv 24 teev tom qab nkag, lawv tau kuaj pom muaj tus mob hnyav ua pa nyuaj ua pa mob coronavirus 2 (SARS-CoV-2) los ntawm polymerase chain reaction testing (Northwell Health Labs) . Lub Tsev Haujlwm Saib Xyuas Kabmob thiab Tiv Thaiv Kab Mob txhais tau hais tias MIS-C tau siv: cov menyuam yaus uas ua npaws, cov pov thawj tseem ceeb ntawm kev mob, pov thawj ntawm Ntau dua lossis sib npaug rau 2 lub cev tsis ua haujlwm, thiab kuaj pom qhov zoo rau tam sim no lossis tsis ntev los no SARS-CoV{{ 11}} tus kab mob los yog muaj kev pom zoo ntawm kev kis tus kab mob COVID-19 nyob rau hauv 4 lub lis piam ntawm cov tsos mob tshwm sim. Cov neeg mob uas cev xeeb tub, cov neeg mob raum hloov pauv, cov neeg mob uas muaj qhov kawgraumkab mob(kwv yees glomerular filtration rate<15 ml/min="" per="" 1.73="" m²="" or="" dialysis),="" or="" those="" transferred="" from="" outside="" of="" the="" health="" system="" were="">
Qhov xwm txheej ntawm AKl
Cov txiaj ntsig tseem ceeb ntawm txoj kev tshawb no yog qhov tshwm sim ntawm AKI. Kev kuaj mob thiab theem ntawm AKI tau ua raws li covLub raumKab mob: Txhim Kho Ntiaj Teb Cov Txheej Txheem (KDIGO) cov lus qhia. Tsuas yog cov ntshav creatinine tau siv los txheeb xyuas thiab theem AKI raws li cov ntaub ntawv ntawm cov zis tso zis hauv cov ntaub ntawv kho mob hluav taws xob tsis tau sau tseg. Tsis muaj leej twg ntawm cov neeg mob muaj cov tshuaj creatinine hauv cov ntshav (txhais tau tias yog creatinine hauv 3 lub hlis tom qab nkag); Yog li ntawd, raws li yav dhau los tau piav nyob rau hauv cov ntaub ntawv, lub hauv paus-kab creatinine yog kwv yees los ntawm rov qab xam los ntawm tus thawj Schwartz formula assumes ib tug glomerular filtration tus nqi rau cov me nyuam (kwv yees glomerular pom tus nqi teem li 120 ml / min ib 1.73 m²). tsis tau sau tseg, qhov nruab nrab qhov siab (Centers for Disease Control and Prevention 50 feem pua) raug imputed rau poj niam txiv neej thiab hnub nyoog (N ¼ 8).26
Koom nrog AKI
Cov txiaj ntsig thib ob suav nrog cov pej xeem thiab cov xwm txheej kho mob cuam tshuam nrog kev txhim kho ntawm AKI. Cov kev ntsuas hauv qab no tau raug soj ntsuam: cov neeg mob cov pej xeem, nthuav tawm cov tsos mob, thiab cov mob sib kis. Kev ntsuas hauv chav kuaj suav nrog cov ntshav electrolytes, creatinine, ntshav urea nitrogen, albumin, d-dimer, inflammatory markers, thiab hematologic markers. Cov ntsiab lus hais txog kev nyob hauv tsev kho mob, xws li kev siv tshuaj vasoactive. iy. Ig, corticosteroids, extracorporeal membrane oxygenation (ECMO), thiab raug rau cov tshuaj nephrotoxic, kuj tau sau. Hauv cov neeg mob nrog MIS.C, 2- cov ntaub ntawv echocardiographic dimensional tau suav nrog. Nadir sab laug ventricular systolic ejection fractions tau siv los txheeb xyuas qhov qis tshaj sab laug ventricular ejection feem hauv lub sijhawm pw hauv tsev kho mob. Systolic dysfunction tau txhais tias yog sab laug ventricular ejection feem<55%. coronary="" artery="" dilation="" was="" defined="" as="">2 hli.
Cov chav kawm kho mob thiab cov txiaj ntsig
Qhov cuam tshuam ntawm AKI (tag nrho cov theem ua ke thiab hnyav, theem 2 thiab 3) ntawm chav kho mob thiab cov txiaj ntsig tau raug soj ntsuam. Cov txiaj ntsig tau suav nrog kev tuag, kev kho lub raum hloov, qhov ntev ntawm lub tshuab ua pa, qhov ntev ntawm kev nyob hauv tsev kho mob, thiab chaw kho mob rau menyuam yaus (PICU) nyob.
Kev txheeb cais
Cov pej xeem hauv paus thiab cov yam ntxwv kho mob tau piav qhia raws li hom kev nkag mus, mob COVID-19, thiab MIS-C, raws li. Cov ntaub ntawv txuas ntxiv tau piav qhia siv qhov nruab nrab thiab qhov sib txawv ntawm qhov sib txawv (IQRs), thiab cov ntaub ntawv categorical tau nthuav tawm raws li qhov ntau thiab tsawg. Mann-Whitney U test, c2 test, Kruskal-Wallis test, thiab Fisher pes tsawg xeem tau siv los sib piv cov yam ntxwv ntawm tus mob COVID-19 thiab MIS-C cov neeg mob uas muaj thiab tsis muaj AKI.
Kev soj ntsuam kev rov qab logistic tau ua los txhawm rau txheeb xyuas cov xwm txheej cuam tshuam nrog AKI (ob qho tib si MIS-C thiab mob hnyav COVID-19 ua ke). Vim tias qhov tsawg AKI zaus, peb tsis tau hloov kho rau cov neeg tsis sib haum xeeb hauv peb cov qauv. Ntau qhov kev txiav txim siab tau siv rau qhov tsis muaj qhov tseem ceeb hauv kev txheeb xyuas regression. Tom qab ntawd, qhov yooj yim linear regression tsom xam tau ua los ntsuas qhov kev sib raug zoo ntawm AKI thiab cov txiaj ntsig txuas ntxiv, suav nrog PICU thiab tsev kho mob ntev ntawm kev nyob thiab lub sijhawm ntev ntawm cov tshuab ua pa. Ob-tailed P < 0.05="" tau="" teeb="" tsa="" raws="" li="" theem="" ntawm="" qhov="" tseem="" ceeb,="" thiab="" spss="" version="" 26="" tau="" siv="" los="" tshuaj="">
TSEEM CEEB
Ntawm 166 tus menyuam yaus uas tau txais tus mob COVID-19 lossis MIS-C, 152 tau ua raws li cov txheej txheem suav nrog. Ntau tshaj 63 feem pua (N ¼ 97) cov neeg mob tau txais kev kho mob rau tus mob COVID-19, thaum 55 tus neeg mob (36.2 feem pua) tau kuaj pom tias muaj MIS-C (Daim duab 1). AKI tsim nyob rau hauv 18 (11.8 feem pua) ntawm tag nrho cov neeg mob. Cov ntaub ntawv pej xeem, nthuav tawm cov tsos mob, thiab qhov chaw sim ntsuas qhov tseem ceeb ntawm cov neeg muaj thiab tsis muaj AKI hauv ob pawg tau muab piv (Table 1 thiab 2).
Tus mob COVID-19
Lub hnub nyoog nruab nrab ntawm cov menyuam uas muaj tus mob COVID{0}} yog 8.2 (IQR, 1.5–13.8) xyoo, thiab ntau dua ib nrab yog txiv neej. Yim tus neeg mob (8.2 feem pua) tsim AKI; 4 nthuav tawm nrog AKI ntawm kev nkag (Table 1, 25, thiab Daim duab 2); 6 (6.2 feem pua) muaj theem 1, thiab 2 muaj theem 3 (Sab Ntxiv Table S1). Tsis muaj qhov sib txawv tseem ceeb hauv hnub nyoog, poj niam txiv neej, haiv neeg, thiab lub cev qhov ntsuas z tau qhab nia ntawm cov menyuam yaus thiab tsis muaj AKI. Txawm hais tias tsis muaj qhov sib txawv tseem ceeb hauv kev nthuav tawm cov tsos mob, 50 feem pua ntawm cov neeg mob AKI nthuav tawm cov tsos mob plab. Cov neeg mob uas muaj AKI nthuav tawm nrog cov tshuaj calcium thiab albumin qis dua (P ¼ 0.047 thiab P ¼ 0.001, feem). Cov qe ntshav dawb hauv nruab nrab (WBC) suav tau ntau dua hauv cov neeg uas muaj AKI piv nrog cov tsis muaj AKI (P ¼ 0.02) (Table 1).
Multisystem inflammatory syndrome nyob rau hauv cov me nyuam
The median age of children hospitalized with MIS-C was 7.5 (IQR, 1.5–13.8) years, and >60 feem pua yog txiv neej. AKI tsim nyob rau hauv 10 (18.2 feem pua) cov neeg mob. Yim (8{27}} feem pua ) ntawm cov neeg mob no tau qhia nrog AKI thaum nkag; 4 (7.3 feem pua) muaj theem 1, 2 (3.6 feem pua) muaj theem 2, thiab 4 (7.3 feem pua) muaj theem 3 (Daim duab 2 thiab Cov Lus Ntxiv S1). Tsis muaj qhov sib txawv tseem ceeb ntawm hnub nyoog, poj niam txiv neej, haiv neeg, lossis haiv neeg ntawm 2 pawg. Cov neeg uas muaj AKI muaj qhov nruab nrab ntawm lub cev qhov hnyav dua z-score piv nrog cov uas tsis tau tsim AKI (P ¼ 0.045). Txhua tus neeg mob hauv pawg MIS-C tau mus pw hauv tsev kho mob menyuam yaus. Txawm hais tias tsis muaj qhov sib txawv tseem ceeb hauv kev nthuav tawm cov tsos mob, txhua tus neeg mob MIS-C nrog AKI nthuav tawm cov tsos mob plab. Cov neeg mob nrog AKI tau qis dua cov ntshav bicarbonate thiab albumin ntawm kev nthuav qhia (P ¼ 0.02 thiab P ¼ 0.004, feem). Baseline C-reactive protein kuj tseem ceeb heev ntawm cov neeg mob MIS-C uas tsim AKI (P <0.0001). txawm="" hais="" tias="" tsis="" yog="" qhov="" tseem="" ceeb,="" cov="" neeg="" mob="" aki="" nthuav="" qhia="" nrog="" ntau="" dua="" wbc="" suav="" (table="">
Echocardiography was available and analyzed for 89% of MIS-C patients (N ¼ 49). The Median left ventricular ejection fraction was lower for those with AKI (49%; IQR, 40%–54%) compared with those without AKI (56%; IQR, 49%–62%) (P ¼ 0.02). Systolic dysfunction occurred in 80% (N ¼ 8) of AKI patients compared with 49% (N ¼ 17) without AKI. Coronary artery dilation (>2 hli) tsis txawv qhov tseem ceeb ntawm cov pab pawg (Table Ntxiv S2).
Hauv paus pej xeem thiab cov yam ntxwv kho mob cuam tshuam nrog AKI
Tsis muaj qhov sib txawv tseem ceeb ntawm hnub nyoog, haiv neeg, lossis nthuav tawm cov tsos mob ntawm cov neeg muaj thiab tsis muaj AKI (Table Ntxiv S3). Cov neeg uas tau txheeb xyuas tias yog Dub muaj 2.86 lub sij hawm siab dua qhov tsis hloov pauv ntawm AKI piv nrog cov uas tsis yog Dub (P ¼ 0.042; 95 feem pua ntawm kev ntseeg siab [CI], 1.04–7.93). Ntawm 60 tus menyuam yaus uas mob hnyav thiab tau mus rau PICU, 28 feem pua (N ¼ 17) muaj AKI (Table Ntxiv S3).
AKI tau cuam tshuam nrog ntau dua WBC suav (qhov sib txawv ntawm qhov sib txawv, 1.11; 95 feem pua CI, 1.04–1.2) thiab qis dua cov ntshav albumin (qhov sib txawv, {{10}}}.17; 95 feem pua CI, 0.07–0.39) ntawm kev nkag (Table Ntxiv S4). Cov kev tshawb pom no tau tuav qhov tseem ceeb hauv kev soj ntsuam thib ob piv rau cov neeg mob hnyav nrog AKI nrog cov neeg mob hnyav uas tsis muaj AKI. Muaj ib qho me me, tab sis qhov tseem ceeb, qhov txawv ntawm qhov muaj C-reactive protein ntau dua ntawm kev nthuav qhia (qhov sib txawv, 1.01; 95 feem pua CI, 1.004-1.01). Txawm li cas los xij, cov kev tshawb pom no tuaj yeem cuam tshuam txog qhov mob hnyav vim tias feem ntau ntawm cov neeg mob AKI tau txais mus rau hauv chav saib xyuas mob hnyav tau muaj C-reactive protein ntau dua, thiab cov kev tshawb pom no tsis tau khaws cia rau hauv qhov kev tshuaj ntsuam thib ob piv rau cov neeg mob hnyav nrog thiab tsis muaj. AKI (Table Ntxiv S2). Ntawm cov neeg mob uas tsim AKI tom qab nkag (N ¼ 5), raug rau cov tshuaj nephrotoxic (xws li angiotensin-hloov enzyme inhibitor / angiotensin receptor blockers, nonsteroidal anti-inflammatory tshuaj, vancomycin, thiab aminoglycosides) kuj cuam tshuam nrog kev loj hlob ntawm AKI (P. ¼0.018; odds ratio, 5.5; 95 feem pua CI, 1.33–22.6).
Cov chav kawm kho mob thiab cov txiaj ntsig
Cov neeg mob AKI tau txais kev kho mob vasopressor ntau dua thiab kev txhawb nqa ionotropic (Table 325). Kev kho lub raum tsis tu ncua, siv cov venovenous hemodiafiltration txuas ntxiv, xav tau nyob rau hauv 2 tus menyuam yaus uas muaj tus kab mob COVID-19, thaum 2 lwm tus xav tau ECMO kev txhawb nqa. Muaj 2 tus neeg tuag nyob rau hauv tus mob COVID-19 pawg, ib qho los ntawm plab hnyuv perforation thiab lwm tus los ntawm mob hypoxic/hypercapnic ua pa tsis ua haujlwm. Yog xav paub ntxiv txog cov txiaj ntsig hauv tsev kho mob los ntawm KDIGO theem ntawm AKI, saib Cov Lus Ntxiv S2.
Tag nrho ntawm 11 (7.2 feem pua) cov neeg mob xav tau cov tshuab ua pa. Ntawm cov neeg kho tshuab cua tshuab, 6 (55 feem pua) tau kuaj pom tias muaj tus mob COVID-19, thaum 5 (45 feem pua) muaj MIS C. Muaj feem ntau ntawm cov tshuab ua pa hauv cov menyuam yaus uas muaj AKI hauv ob qho COVID{{8 }} thiab MIS-C pawg piv nrog cov tsis muaj AKI (P < {{10}}}.001="" thiab="" p="" ¼="" 0.001,="">
AKI tau daws ua ntej tso tawm hauv tag nrho tab sis 2 tus neeg mob uas muaj tus mob COVID-19 thiab 1 tus neeg mob MIS-C. Tsis muaj qhov sib txawv tseem ceeb hauv cov ntshav creatinine lossis kwv yees glomerular pom tus nqi ntawm kev tso tawm ntawm cov neeg uas muaj thiab tsis muaj AKI.
Hauv kev txheeb xyuas qhov tsis hloov pauv, cov neeg mob uas muaj tag nrho cov theem ntawm qhov kawg nce ntev ntawm PICU nyob (95 feem pua CI, 0.86–9; P ¼ 0.025) . Tsis tas li ntawd, cov neeg mob AKI muaj qhov tseem ceeb nyob hauv tsev kho mob ntev dua 8.4 hnub piv nrog cov neeg mob uas tsis muaj AKI (95 feem pua CI, 4.4–6.7; P < 0.0001).="" peb="" tsis="" tau="" soj="" ntsuam="" ib="" qho="" kev="" koom="" tes="" tseem="" ceeb="" nrog="" kev="" tuag="" lossis="" ntev="" ntawm="" cov="" tshuab="" ua="" pa="" (table="">
Kev sib tham
Hauv txoj kev tshawb no, AKI tau tsim nyob rau hauv 11.8 feem pua ntawm cov pab pawg: 8.2 feem pua hauv COVID-19 thiab 18.2 feem pua hauv MIS-C. Cov neeg mob feem ntau tsim AKI ntawm kev nkag, thiab AKI tau daws yuav luag txhua kis ua ntej tso tawm. Qe serum albumin thiab ntau dua WBC suav tau cuam tshuam nrog AKI hauv cov menyuam yaus uas muaj tus mob COVID-19 thiab MIS-C. MIS-C cov neeg mob nrog AKI muaj ntau systolic dysfunction ntawm echocardiograms piv nrog cov tsis muaj AKI. AKI, hauv cov qauv tsis hloov kho, tau cuam tshuam nrog PICU ntev dua thiab nyob hauv tsev kho mob ntev.
AKI tau tshaj tawm tias tshwm sim nyob rau hauv qis dua ib nrab ntawm cov neeg laus nrog COVID-19.5,7,8 Hauv kev sib piv, 8.2 feem pua ntawm cov neeg mob uas mob COVID-19 hauv peb txoj kev tshawb fawb tau tsim AKI. Cov kev tshawb fawb tsis ntev los no hauv cov pab pawg menyuam yaus kwv yees COVID-19- koom nrog AKI kom nyob nruab nrab ntawm 1.3 feem pua thiab 44 feem pua. 17–20 Qhov sib txawv ntawm cov nqi no feem ntau yog vim muaj qhov sib txawv ntawm cov neeg uas tau kawm (xws li, pw hauv tsev kho mob lossis mob hnyav) thiab cov ntsiab lus ntawm AKI. Txawm li cas los xij, qhov tshwm sim ntawm AKI hauv cov menyuam yaus uas muaj tus mob COVID-19 tau ua pov thawj tsis tu ncua kom tsawg dua li cov neeg laus. Cov neeg laus uas muaj COVID-19-txog AKI muaj feem ntau ntawm cov mob comorbid, xws li ntshav qab zib, mob raum, thiab mob plawv tsis ua hauj lwm.8 Hauv kev sib piv, peb cov neeg kawm tau noj qab nyob zoo, nrog tsawg dua ntawm comorbid. cov xwm txheej thiab yog li ntau lub raum cia.
AKI rates in children with MIS-C are more prevalent compared with children with acute COVID-19. Case series have estimated AKI occurrence in 15% to 73% of cases.18,23,27 The incidence rate of AKI in MIS-C patients in this study was >18 feem pua. Cov tsos mob tshwm sim ntawm peb pawg MISC feem ntau yog kub taub hau, cov tsos mob ntawm plab hnyuv, thiab cov pob khaus ntawm daim tawv nqaij, uas zoo ib yam nrog cov ntaub ntawv tam sim no.27–30 Cov kev tshawb fawb tsis ntev los no tau sau tseg tias muaj ntau dua ntawm MIS-C hauv African American / Afro-Caribbean cov pej xeem; Txawm li cas los xij, tsis muaj qhov sib txawv tseem ceeb ntawm haiv neeg thiab AKI hauv peb pawg MIS-C.23 Qhov no yuav yog vim qhov kev txwv qhov loj me vim tias muaj ntau dua ob npaug ntawm qhov tsis sib xws ntawm AKI (MIS-C thiab mob hnyav COVID- 19 ua ke) hauv cov neeg mob uas pom tias yog Dub. Qhov no yog raws li qhov tsis txaus ntseeg ntawm cov neeg mob thiab cov neeg tuag uas cuam tshuam nrog COVID-19 tau tshaj tawm hauv African Asmeskas cov menyuam yaus thiab cov neeg laus.23 Cov ntawv tshaj tawm tam sim no tau teeb pom kev hnyav ntawm MIS-C nrog nce tus nqi ntawm PICU nkag thiab xav tau kev txhawb nqa inotropic thiab ECMO.22,23,27–30 Feem ntau cov neeg mob MIS-C hauv peb pawg neeg tau txais mus rau PICU thiab xav tau kev kho mob nrog inotropes thiab vasopressors. Txawm hais tias cov neeg mob MIS-C tau tshaj tawm tias muaj cov neeg tuag sib piv rau cov neeg laus uas muaj tus kab mob COVID-18}, tsis muaj neeg tuag hauv peb pawg MIS-C.23
COVID-19-txog AKI tej zaum yuav cuam tshuam nrog cov kab mob hnyav thiab mob ntsws. Hirsch et al. pom tias cov tshuab ua pa thiab cov vasopressors yog qhov muaj feem cuam tshuam rau AKI txoj kev loj hlob hauv cov neeg laus.5 Hauv txoj kev tshawb no, txhua tus neeg mob AKI yuav luag ib txwm mob hnyav thiab muaj tus nqi siab ntawm cov tshuab ua pa thiab xav tau kev txhawb nqa vasoactive. Txawm li cas los xij, raws li cov neeg mob feem ntau tsim AKI ntawm kev nkag mus, lub sijhawm ntawm AKI thiab lub tshuab ua pa tsis tuaj yeem txaus siab rau. Ob tus neeg mob uas muaj tus mob COVID-19 xav tau kev kho lub raum tsis tu ncua, hos 2 lwm tus xav tau kev txhawb nqa ECMO. Txawm hais tias muaj cov ntaub ntawv qhia txog kev xav tau ntau ntxiv rau ECMO thiab kev kho mob raum tsis tu ncua hauv cov neeg mob MIS-C, tsis muaj ib tus neeg mob MIS-C tau kawm yuav tsum tau kho cov kev kho no. Thaum kawg, AKI, hauv cov qauv tsis hloov kho, tau cuam tshuam nrog PICU ntev dua thiab nyob hauv tsev kho mob. Lub koom haum no, txawm hais tias yuav tsum tau txhais nrog ceev faj, yog ua raws li yav dhau los qhia kev tshawb pom ntawm AKI hauv cov neeg mob hnyav.31,32
Obesity is associated with severe COVID-19 disease and AKI in adults.33,34 This finding was not observed within our pediatric acute COVID-19 cohort; however, those with MISC and AKI had higher body mass index z-scores. Reports demonstrate that >50 feem pua ntawm cov neeg mob MIS-C tau pom tias rog rog. Qhov no tej zaum yuav yog vim lub hauv paus inflammatory milieu pom nyob rau hauv rog rog thiab / los yog ntau ntxiv ntawm comorbidities.23
Cov neeg mob feem ntau tsim AKI rau thawj hnub ntawm kev mus pw hauv tsev kho mob. Qhov tshwm sim no tau tshaj tawm hauv ntau qhov kev tshawb fawb rau cov neeg laus uas cov neeg laus feem ntau tsim AKI rau kev nkag los yog hnub 1 ntawm kev mus pw hauv tsev kho mob.5,8 Cov kev tsis txaus siab ntawm plab hnyuv yog cov tsos mob tshwm sim tshaj plaws ntawm cov menyuam yaus uas muaj AKI, uas tej zaum yuav qhia tau tias muaj prerenal etiology vim poob thiab lub cev qhuav dej. . Lub koom haum tseem ceeb ntawm qis nruab nrab sab laug ventricular ejection feem, systolic dysfunction, thiab AKI hauv MIS-C cov neeg mob tuaj yeem qhia tau tias cov zis qis qis kuj tau ua rau AKI. Qhov tseem ceeb tshaj, tsis yog txhua tus neeg mob uas muaj lub plawv tsis ua haujlwm sab laug thiab / lossis poob siab, xav tau vasoactive, tsim AKI, tawm tswv yim txog ntau yam kev raug mob.
Lwm qhov kev ua tau zoo ntawm AKI nyob rau hauv mob hnyav COVID-19 suav nrog kev mob thiab raug rau nephrotoxins. Cov neeg laus COVID-19-txog AKI muaj feem cuam tshuam nrog cov cim ua mob ntxiv.7,8 Tib lub koom haum tau txais txiaj ntsig zoo hauv pawg kws kho mob no. Kev suav WBC siab dua, C-reactive protein ntau dua, thiab qis dua cov ntshav albumin tau cuam tshuam nrog AKI hauv tus mob COVID-19 thiab MIS-C. Lower serum albumin thiab thiaj li txo qis cov calcium hauv cov ntshav tuaj yeem yog vim muaj cov kab mob capillary permeability ntxiv rau cov kab mob hauv lub cev. Iatrogenic ua rau, xws li cov tshuaj nephrotoxic, raws li tau piav qhia nyob rau hauv cov ntaub ntawv ntev, tej zaum yuav ua rau AKI zoo li.35 Hauv peb txoj kev tshawb fawb, ntawm 5 tus neeg mob uas tsim AKI tom qab nkag mus, nephrotoxic raug tshuaj (angiotensin-hloov enzyme inhibitors / angiotensin receptor. blockers, nonsteroidal anti-inflammatory tshuaj, vancomycin, thiab aminoglycosides) tau txuam nrog AKI.
Muaj ob peb yam kev txwv rau peb txoj kev kawm. Peb txoj kev tshawb fawb muaj cov qauv me me, thiab feem ntau AKI tau tsim los ntawm kev nkag, ua rau nws nyuaj rau kos cov koom haum ua rau muaj kev sib koom siab thiab kho rau cov neeg tsis sib haum xeeb. Raws li nrog txhua qhov kev tshawb fawb rov qab, muaj peev xwm ua kom paub tseeb qhov tsis ncaj ncees. Txawm li cas los xij, feem ntau cov neeg mob COVID-19 thiab MIS-C muaj cov txheej txheem metabolic ntawm kev nthuav qhia thiab thaum lawv nyob hauv tsev kho mob los ntsuas AK. Kev siv cov ntshav creatinine yam tsis muaj cov zis tso zis thiab rov qab xam cov txiaj ntsig creatinine hauv qab kuj tseem tuaj yeem kwv yees qhov tshwm sim ntawm AKI.
Txawm hais tias cov kev txwv no, peb txoj kev tshawb fawb muaj qhov tseem ceeb tshaj plaws. Peb cov pej xeem kawm suav nrog cov neeg mob hauv cheeb tsam New York City ntau dua ntawm qhov chaw tseem ceeb ntawm COVID-19 tshwm sim uas sawv cev rau ntau haiv neeg, haiv neeg, thiab kev noj qab haus huv ntawm cov menyuam yaus. Tsis tas li ntawd, KDIGO AKI cov lus txhais tau siv los sib piv peb cov nqi nrog cov neeg laus thiab cov ntaub ntawv los ntawm lwm lub chaw.
Xaus
Hauv kev xaus, AKI tau tshwm sim hauv 11.8 feem pua ntawm cov menyuam yaus uas muaj tus mob COVID-19 thiab MIS-C. Cov menyuam yaus uas muaj COVID-19-txog AKI tau nce WBC suav thiab txo qis cov ntshav albumin hauv kev nkag mus, uas tuaj yeem cuam tshuam txog qhov mob hnyav ntawm lub luag haujlwm hauv kev txhim kho thiab kev ua tiav ntawm AKI. Tsis tas li ntawd, qhov txo qis hauv cov hlab ntsha thiab qhov sib faib / mob plawv tuaj yeem ua rau AKI txoj kev loj hlob hauv pawg. Pediatric COVID-19-txog AKI, zoo ib yam li cov lus ceeb toom hauv cov kev tshawb fawb AKI loj dua, tau cuam tshuam nrog cov txiaj ntsig tsis zoo, xws li nce PICU thiab tsev kho mob ntev nyob. Kev tshawb fawb ntxiv hauv cov pab pawg loj dua yog xav tau los ua tus yam ntxwv ntawm AKI qhov kev pheej hmoo ntawm cov menyuam yaus uas muaj tus kab mob COVID-19 thiab MIS-C.
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