Pediatric inflammatory multisystem syndrome associated with sarscov-2:a case series quantitative systematic review

AIMS & OBJECTIVES: To develop a comprehensive description of multisystem inflammatory syndrome temporally associated with SARS -Cov-2 (PIMS-TS) by conducting a case series quantitative systematic review. METHODS: PIMS-TS studies were identified by searching Pub Med and Embase from May 1st to July 1st 2020.We extracted data on demographics, clinical presentation,laboratory, imaging studies, treatment and PICU outcomes. RESULTS: 11 studies were identified including 468 cases.The avergage age was 9.2 years (95% CI 8.5-9.9y) and 54%(95% CI 48-61) were males.SARS -CoV-2 RT-PCR was positive in 38%(95% CI 52-63) and serology in 68%(95%CI 50-84).All patients were febrile at presentation and gastrointestinal symptoms were reported in 85%(95%CI 74-94),shock in 76 %(95%CI 55-93) and rash in 58%((95%CI 52-63). 26% (95%CI 13-40) of cases fulfilled the AHA Kawasaki criteria.Laboratory markers of inflammation and cardiac injury (C reactive protein,procalcitonin, ferritin,D dimer,NTproBNP) were consistently elevated. Left ventricular dysfunction was found in 72%(95% CI52-89).Overall,82%(95% CI 68-93%) of patients required ICU,62% vasoactive drugs and 59%(95%CI 40-77) respiratory support. 25 patients were placed on ECMO. Intravenous immunoglobulin was used in 79%(95%CI 66-90) followed by steroids in 47%(95%34-59).ICU mean length of stay was 6 days (95% CI 4-7 d) .7 deaths ocurred,5 of them during ECMO run. CONCLUSIONS: PIMS TS is a rare and heterogeneous disease.PICU admission was frequent and mortality was low. This quantitative pooled data could help clinicians to improve diagnosis and prompt treatment of this new condition.