期刊
JOURNAL OF CLINICAL INVESTIGATION
卷 130, 期 11, 页码 5967-5975出版社
AMER SOC CLINICAL INVESTIGATION INC
DOI: 10.1172/JCI140970
关键词
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资金
- CHOP Frontiers Program Immune Dysregulation Team
- National Institute of Allergy and Infectious Diseases (NIAID) [R01AI121250, R01AI103280, R01AI123433, R21AI144472, K08 AI136660, K08AI135091]
- National Cancer Institute (NCI) [R01CA193776, X01HD100702-01, 5UG1CA233249, R01A1123538]
- Leukemia and Lymphoma Society
- Cookies for Kids Cancer
- Alexs Lemonade Stand Foundation for Childhood Cancer
- Stand UP 2 Cancer
- Childrens Oncology Group
- Team Connor
- Kate Amato Foundations
- Burroughs Wellcome Fund CAMS
- Clinical Immunology Society
- American Academy of Allergy, Asthma, and Immunology
- Institute for Translational Medicine and Therapeutics at the University of Pennsylvania
BACKGROUND. Initial reports from the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology. METHODS. We prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data. RESULTS. Twenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines IL-10. IL-6, IL-8, and TNF-alpha) contributed to the analysis. TNF-alpha and IL-10 discriminated between patients with MIS-C and severe COVID-19. The presence of burr cells on blood smears, as well as Cts, differentiated between patients with severe COVID-19 and those with MIS-C. CONCLUSION. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and those with severe COVID-19.
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