Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory Condition: An Analysis of the VIRUS COVID-19 Registry

Imran A Sayed, Utpal Bhalala, Larisa Strom, Sandeep Tripathi, John S Kim, Kristina Michaud, Kathleen Chiotos, Heda R Dapul, Varsha P Gharpure, Erica C Bjornstad, Julia A Heneghan, Katherine Irby, Vicki Montgomery, Neha Gupta, Manoj Gupta, Karen Boman, Vikas Bansal, Rahul Kashyap, Allan J Walkey, Vishakha K Kumar, Katja M Gist, VIRUS Investigators, Imran A Sayed, Utpal Bhalala, Larisa Strom, Sandeep Tripathi, John S Kim, Kristina Michaud, Kathleen Chiotos, Heda R Dapul, Varsha P Gharpure, Erica C Bjornstad, Julia A Heneghan, Katherine Irby, Vicki Montgomery, Neha Gupta, Manoj Gupta, Karen Boman, Vikas Bansal, Rahul Kashyap, Allan J Walkey, Vishakha K Kumar, Katja M Gist, VIRUS Investigators

Abstract

Background: Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C).

Methods: Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality.

Results: Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes.

Conclusions: GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C.

Trial registration: ClinicalTrials.gov NCT04323787.

Conflict of interest statement

U.B. is currently funded by National Institute of Health (Site Principal Investigator for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site Principal Investigator for Pediatric Resuscitation Quality Collaborative-PediResQ), Voelcker Pilot Grant (PI for project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to Society of Critical Care Medicine VIRUS (COVID-19) Registry and Society of Critical Care Medicine VIRUS electronic medical record automation pilot. The other authors have no conflicts of interest to disclose.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

References

    1. Godfred-Cato S, Bryant B, Leung J, et al. .; California MIS-C Response Team. COVID-19-associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1074–1080.
    1. Dorrell RD, Dougherty MK, Barash EL, et al. . Gastrointestinal and hepatic manifestations of COVID-19: a systematic review and meta-analysis. JGH Open 2020;5:107–115.
    1. Tian Y, Rong L, Nian W, et al. . Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51:843–851.
    1. Dufort EM, Koumans EH, Chow EJ, et al. .; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347–358.
    1. Elmunzer BJ, Spitzer RL, Foster LD, et al. .; North American Alliance for the Study of Digestive Manifestations of COVID-19. Digestive manifestations in patients hospitalized with coronavirus disease 2019. Clin Gastroenterol Hepatol. 2021;19:1355–1365.e4.
    1. Minodier L, Charrel RN, Ceccaldi PE, et al. . Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J. 2015;12:215.
    1. Tullie L, Ford K, Bisharat M, et al. . Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. Lancet Child Adolesc Health. 2020;4:e19–e20.
    1. Chen R, Yu YL, Li W, et al. . Gastrointestinal symptoms associated with unfavorable prognosis of COVID-19 patients: a retrospective study. Front Med (Lausanne). 2020;7:608259.
    1. Dong ZY, Xiang BJ, Jiang M, et al. . The prevalence of gastrointestinal symptoms, abnormal liver function, digestive system disease and liver disease in COVID-19 infection: a systematic review and meta-analysis. J Clin Gastroenterol. 2021;55:67–76.
    1. Sulaiman T, Algharawi AA, Idrees M, et al. . The prevalence of gastrointestinal symptoms among patients with COVID-19 and the effect on the severity of the disease. JGH Open 2020;4:1162–1166.
    1. Gonzalez Jimenez D, Velasco Rodríguez-Belvís M, Ferrer Gonzalez P, et al. . COVID-19 gastrointestinal manifestations are independent predictors of PICU admission in hospitalized pediatric patients. Pediatr Infect Dis J. 2020;39:e459–e462.
    1. Walkey AJ, Kumar VK, Harhay MO, et al. . The viral infection and respiratory illness universal study (VIRUS): an International Registry of Coronavirus 2019-related critical illness. Crit Care Explor. 2020;2:e0113.
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
    1. Kim L, Whitaker M, O’Halloran A, et al. .; COVID-NET Surveillance Team. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1081–1088.
    1. Clinical spectrum of Sars Cov-2 infection. 2020. Available at: .
    1. Center for Disease Control and Prevention, Emergency Preparedness and Response. Multisystem inflammatory syndrome in children (Mis-C) associated with coronavirus disease 2019 (COVID-19). 2020. Available at: .
    1. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. .; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020;174:868–873.
    1. Feldstein LR, Tenforde MW, Friedman KG, et al. .; Overcoming COVID-19 Investigators. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA. 2021;325:1074–1087.
    1. Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J. 2020;39:355–368.
    1. Mao R, Qiu Y, He JS, et al. . Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:667–678.
    1. Giacomet V, Barcellini L, Stracuzzi M, et al. .; COVID-19 Pediatric network. Gastrointestinal symptoms in severe COVID-19 children. Pediatr Infect Dis J. 2020;39:e317–e320.
    1. Miller J, Cantor A, Zachariah P, et al. . Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children that is related to coronavirus disease 2019: a single center experience of 44 cases. Gastroenterology. 2020;159:1571–1574.e2.
    1. Hoste L, Van Paemel R, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr. 2021;180:2019–2034.
    1. Tang Y, Li W, Baskota M, et al. . Multisystem inflammatory syndrome in children during the coronavirus disease 2019 (COVID-19) pandemic: a systematic review of published case studies. Transl Pediatr. 2021;10:121–135.
    1. Radia T, Williams N, Agrawal P, et al. . Multi-system inflammatory syndrome in children & adolescents (MIS-C): a systematic review of clinical features and presentation. Paediatr Respir Rev. 2021;38:51–57.
    1. Kaushik A, Gupta S, Sood M, et al. . A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39:e340–e346.
    1. Sahn B, Eze OP, Edelman MC, et al. . Features of intestinal disease associated with COVID-related multisystem inflammatory syndrome in children. J Pediatr Gastroenterol Nutr. 2021;72:384–387.
    1. Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25:464–469.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel