1. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome
- Author
-
Lo Vecchio, Andrea, Garazzino, Silvia, Smarrazzo, Andrea, Venturini, Elisabetta, Poeta, Marco, Berlese, Paola, Denina, Marco, Meini, Antonella, Bosis, Samantha, Galli, Luisa, Cazzato, Salvatore, Nicolini, Giangiacomo, Vergine, Gianluca, Giacchero, Roberta, Ballardini, Giuseppina, Dodi, Icilio, Salvini, Filippo Maria, Manzoni, Paolo, Ferrante, Giuliana, Quadri, Vera, Campana, Andrea, Badolato, Raffaele, Villani, Alberto, Guarino, Alfredo, Gattinara, Guido Castelli, Gianluca Tornese, Lo Vecchio, Andrea, Garazzino, Silvia, Smarrazzo, Andrea, Venturini, Elisabetta, Poeta, Marco, Berlese, Paola, Denina, Marco, Meini, Antonella, Bosis, Samantha, Galli, Luisa, Cazzato, Salvatore, Nicolini, Giangiacomo, Vergine, Gianluca, Giacchero, Roberta, Ballardini, Giuseppina, Dodi, Icilio, Salvini, Filippo Maria, Manzoni, Paolo, Ferrante, Giuliana, Quadri, Vera, Campana, Andrea, Badolato, Raffaele, Villani, Alberto, Guarino, Alfredo, Gattinara, Guido Castelli, Tornese, Gianluca, Lo Vecchio, A., Garazzino, S., Smarrazzo, A., Venturini, E., Poeta, M., Berlese, P., Denina, M., Meini, A., Bosis, S., Galli, L., Cazzato, S., Nicolini, G., Vergine, G., Giacchero, R., Ballardini, G., Dodi, I., Salvini, F. M., Manzoni, P., Ferrante, G., Quadri, V., Campana, A., Badolato, R., Villani, A., Guarino, A., Gattinara, G. C., and Andrea Lo Vecchio, Silvia Garazzino, Andrea Smarrazzo, Elisabetta Venturini, Marco Poeta, Paola Berlese, Marco Denina, Antonella Meini, Samantha Bosis, Luisa Galli, Salvatore Cazzato, Giangiacomo Nicolini, Gianluca Vergine, Roberta Giacchero, Giuseppina Ballardini, Icilio Dodi, Filippo Maria Salvini, Paolo Manzoni, Giuliana Ferrante, Vera Quadri, Andrea Campana, Raffaele Badolato, Alberto Villani, Alfredo Guarino, Guido Castelli Gattinara
- Subjects
Male ,Gastrointestinal ,Prognosi ,Gastrointestinal Diseases ,Gastrointestinal Disease ,Multisystem Inflammatory Syndrome ,COVID-19 ,Child ,Child, Preschool ,Female ,Humans ,Prognosis ,Radiography ,Retrospective Studies ,SARS-CoV-2 ,Systemic Inflammatory Response Syndrome ,macromolecular substances ,SarsCoV2 ,Pediatrics ,Retrospective Studie ,Preschool ,Children ,Original Investigation ,Research ,Gastrointestinal, Children, SARS-CoV-2, Multisystem Inflammatory Syndrome ,General Medicine ,Settore MED/38 ,gastrointestinal ,Online Only ,Human - Abstract
Key Points Question Is COVID-19 associated with severe gastrointestinal manifestations in children? Findings In this multicenter cohort study of 685 Italian children with COVID-19, 10% showed severe gastrointestinal involvement characterized by diffuse adeno-mesenteritis, appendicitis, abdominal fluid collection, ileal intussusception, or pancreatitis. Children older than 5 years and those presenting with abdominal pain, leukopenia, or receiving a diagnosis of multisystem inflammatory syndrome were more likely to have severe gastrointestinal manifestations. Meaning Severe gastrointestinal involvement is not uncommon in children with COVID-19, and awareness about its frequency and presentation may help practitioners to appropriately manage children at risk of severe outcomes., Importance Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. Objective To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. Design, Setting, and Participants A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged 10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). Conclusions and Relevance In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications., This cohort study assesses the clinical, radiological, and histopathologic gastrointestinal characteristics of a large cohort of children with acute SARS-CoV-2 infection or multisystem inflammatory syndrome in children to identify factors associated with severe gastrointestinal manifestations and describes their clinical course and outcome.
- Published
- 2021