2
|
Lockhart-Bouron M, Vanel N, Levy M, Briant AR, Javouhey E, Breinig S, Dina J, Caseris M, Angoulvant F, Leteurtre S, Recher M, Brossier DW. Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry. World J Pediatr 2024:10.1007/s12519-023-00791-x. [PMID: 38506979 DOI: 10.1007/s12519-023-00791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. METHODS This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. RESULTS There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. CONCLUSIONS SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.
Collapse
Affiliation(s)
- Marguerite Lockhart-Bouron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Noémie Vanel
- Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Anaïs R Briant
- Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France
| | | | - Sophie Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Toulouse, France
| | - Julia Dina
- Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France
- Medical School, Université Caen Normandie, 14000, Caen, France
| | - Marion Caseris
- Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Angoulvant
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stéphane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - David W Brossier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- Medical School, Université Caen Normandie, 14000, Caen, France.
- Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France.
- CHU Sainte Justine Research Center, Montréal, Canada.
| |
Collapse
|
3
|
Butters C, Benede N, Moyo-Gwete T, Richardson SI, Rohlwink U, Shey M, Ayres F, Manamela NP, Makhado Z, Balla SR, Madzivhandila M, Ngomti A, Baguma R, Facey-Thomas H, Spracklen TF, Day J, van der Ross H, Riou C, Burgers WA, Scott C, Zühlke L, Moore PL, Keeton RS, Webb K. Comparing the immune abnormalities in MIS-C to healthy children and those with inflammatory disease reveals distinct inflammatory cytokine production and a monofunctional T cell response. Clin Immunol 2024; 259:109877. [PMID: 38141746 DOI: 10.1016/j.clim.2023.109877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe, hyperinflammatory disease that occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The underlying immune pathology of MIS-C is incompletely understood, with limited data comparing MIS-C to clinically similar paediatric febrile diseases at presentation. SARS-CoV-2-specific T cell responses have not been compared in these groups to assess whether there is a T cell profile unique to MIS-C. In this study, we measured inflammatory cytokine concentration and SARS-CoV-2-specific humoral immunity and T cell responses in children with fever and suspected MIS-C at presentation (n = 83) where MIS-C was ultimately confirmed (n = 58) or another diagnosis was made (n = 25) and healthy children (n = 91). Children with confirmed MIS-C exhibited distinctly elevated serum IL-10, IL-6, and CRP at presentation. No differences were detected in SARS-CoV-2 spike IgG serum concentration, neutralisation capacity, antibody dependant cellular phagocytosis, antibody dependant cellular cytotoxicity or SARS-CoV-2-specific T cell frequency between the groups. Healthy SARS-CoV-2 seropositive children had a higher proportion of polyfunctional SARS-CoV-2-specific CD4+ T cells compared to children with MIS-C and those with other inflammatory or infectious diagnoses, who both presented a largely monofunctional SARS-CoV-2-specific CD4+ T cell profile. Treatment with steroids and/or intravenous immunoglobulins resulted in rapid reduction of inflammatory cytokines but did not affect the SARS-CoV-2-specific IgG or CD4+ T cell responses in MIS-C. In these data, MIS-C had a unique cytokine profile but not a unique SARS-CoV-2 specific humoral or T cell cytokine response.
Collapse
Affiliation(s)
- Claire Butters
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Ntombi Benede
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Thandeka Moyo-Gwete
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa.
| | - Simone I Richardson
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa.
| | - Ursula Rohlwink
- Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Crick African Network, The Francis Crick Institute, Midland Road, London NW1 1AT, United Kingdom.
| | - Muki Shey
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Department of Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Frances Ayres
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa.
| | - Nelia P Manamela
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa.
| | - Zanele Makhado
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa
| | - Sashkia R Balla
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa.
| | - Mashudu Madzivhandila
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa
| | - Amkele Ngomti
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Richard Baguma
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa
| | - Heidi Facey-Thomas
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa.
| | - Timothy F Spracklen
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Cape Heart Institute, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Jonathan Day
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa
| | - Hamza van der Ross
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa.
| | - Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Wendy A Burgers
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Christiaan Scott
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Clinical Research Centre, University of Cape Town, Groote Schuur Hospital, Observatory, 7935 Cape Town, South Africa.
| | - Liesl Zühlke
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Cape Heart Institute, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, 7501 Cape Town, South Africa.
| | - Penny L Moore
- SA MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Services, Modderfontein Road, Sandringham, 2192 Johannesburg, South Africa; Centre for the AIDS Programme of Research in South Africa, Umbilo Road, 4001 Durban, South Africa.
| | - Roanne S Keeton
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Anzio Road, Observatory, 7935 Cape Town, South Africa.
| | - Kate Webb
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700 Cape Town, South Africa; Crick African Network, The Francis Crick Institute, Midland Road, London NW1 1AT, United Kingdom.
| |
Collapse
|