scholarly journals Challenges of Diagnosing Viral Myocarditis in Adolescents in the Era of COVID-19 and MIS-C

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hemali P. Shah ◽  
Richard Frye ◽  
Sunny Chang ◽  
Erin Faherty ◽  
Jeremy Steele ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Viral Myocarditis ◽  
Shortness Of Breath ◽  
Chest Tightness ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Clinical Presentations ◽  
Inflammatory Syndrome ◽  
D Dimer

Myocarditis has a wide array of clinical presentations ranging from asymptomatic to sudden cardiac death. Pediatric myocarditis is a rare disease, with an estimated annual incidence of 1 to 2 per 100,000 children though its true prevalence remains unknown due to its variable and often subclinical presentation. The diagnosis of myocarditis is challenging in the era of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C), which can have overlapping clinical conundrum. Here, we present a case of a 17-year-old male presenting with chest tightness, shortness of breath, and electrocardiogram (EKG) findings concerning for myocardial injury along with elevated inflammatory markers such as D-dimer, ESR (Erythrocyte Sedimentation Rate), and CRP (C-Reactive Protein). We discuss the key elements of our clinical experience with this case and review the literature for pediatric myocarditis, with a focus on differentiating it from MIS-C in the current COVID-19 pandemic era.

scholarly journals The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

2021 ◽  
Author(s):  
Yan Zhao ◽  
Li-juan Yin ◽  
Jenil Patel ◽  
Lei Tang ◽  
Ying Huang
Keyword(s):  
Inflammatory Markers ◽  
Meta Analysis ◽  
Absolute Lymphocyte Count ◽  
Older Children ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Quality Check ◽  
Inflammatory Syndrome ◽  
D Dimer

Abstract As per the indicated need in literature, we conducted a systematic review and meta-analysis to characterize inflammatory markers of MIS-C patients with COVID-19, Kawasaki disease (KD), and coronary artery abnormalities. We searched nine databases for studies on inflammatory markers of MIS-C. After quality check, data were pooled using a fixed- or random-effects model. Inflammatory markers included white blood cell count (WBC) or leukocytes, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, lactate dehydrogenase (LDH), fibrinogen and erythrocyte sedimentation rate (ESR) for comparisons by severity and age. Twenty studies with 2,990 participants yielded 684 MIS-C patients. Compared to non-severe COVID-19 patients, MIS-C patients had lower ALC and higher ANC, CRP and D-dimer levels. Compared to severe COVID-19 patients, MIS-C patients had lower LDH and PLT counts and higher ESR levels. Compared to KD patients, MIS-C patients had lower ALC and PLT, and higher CRP and ferritin levels. Severe MIS-C patients had higher levels of WBC, CRP, D-dimer and ferritin. For MIS-C, younger children had lower CRP and ferritin levels than medium-aged/older children. Measurement of inflammatory markers might assist clinicians in accurate evaluation and diagnosis of MIS-C and the associated disorders.

scholarly journals SARS‐CoV‐2 viremia is associated with inflammatory, but not cardiovascular biomarkers, in patients hospitalized for COVID‐19

2021 ◽  
Author(s):  
Peder L. Myhre ◽  
Christian Prebensen ◽  
Christine Monceyron Jonassen ◽  
Jan Erik Berdal ◽  
Torbjørn Omland
Keyword(s):  
Myocardial Injury ◽  
Prospective Observational Study ◽  
Cardiac Tissue ◽  
Troponin T ◽  
Myocardial Dysfunction ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Lower Oxygen ◽  
Cardiovascular Biomarkers ◽  
D Dimer

Abstract Background COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 (78%) at day 3. Patients were aged 60±15 years, 71 (58%) male, 68 (55%) Caucasian and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently male, had more diabetes mellitus and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin and ferritin (all <0.001), but comparable levels of cardiac troponin T (cTnT; p=0.09), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP; p=0.27) and D‐dimer (p=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT. Conclusions SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia.

scholarly journals Clinical Characteristics and Factors Associated with Unfavorable Outcomes of Pediatric Inflammatory Multisystem Syndrome Related to COVID-19 in Lima-Peru

2021 ◽  
Author(s):  
Olguita del Aguila ◽  
Jesús Dominguez-Rojas ◽  
Kenny Chonlon-Murillo ◽  
Aida Borcic ◽  
Sandra Sánchez ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Myocardial Injury ◽  
Coronary Aneurysm ◽  
C Reactive Protein ◽  
Factors Associated ◽  
Reactive Protein ◽  
Robust Variance ◽  
Organic Dysfunction ◽  
Epidemiological Profile ◽  
Inflammatory Syndrome

Abstract Objective: Describe the clinical-epidemiological profile and determine the factors associated with unfavorable outcomes of pediatrics multisystemic inflammatory syndrome (SIM-P) related to COVID-19 at Edgardo Rebagliati Martins National Hospital (HNERM), Lima-Perú, from April to September 2020. Materials and methods: Retrospective cohort in children under 14 years of age. The current criteria were used for the diagnosis of SIM-P. The effect size was estimated with relative risk (RR) and 95% confidence intervals, using a generalized linear Poisson family model with robust variance. Results: 43 patients were included, 22 (51.2%) Kawasaki Disease (EK), 10 (23.3%) shock, and 11(25.6%) fever with inflammatory markers. The median age was 8 years, most men, without comorbidity, with negative molecular test and positive IgG. Gastrointestinal and mucocutaneous manifestations predominated, with altered inflammatory markers and myocardial injury. Most required intravenous immunoglobulin (IVIG), aspirin (AAS), corticosteroids and antibiotics. More than a third required VMI, ICU and developed organic dysfunction, with a lethality of 4.6% (2/43). Increasing lethality to 20% (2/10) in the shock subgroup. Five were found (14.7%) coronary aneurysm. Having some comorbidity (RR 1.79; IC95%1.02-3.14), C-reactive protein ≥ 10 mg/dL (RR 2.09; IC95%1.15-3.79), and SatO2 ≤92 in emergency (RR 2.84; IC95%1.47-5.50) was morelikely to betransferred to ICU. In addition, those with some comorability (RR 2.23; IC95%1.04-4.79), with lymphopenia <500cel/mL (RR 2.8; IC95%1.24-6.30), and with d≥ 3 mg/L (RR 3.57; IC95%1.23-10.38) were more likely to require VMI. Conclusion: Active monitoringis an eye to make early diagnosis and management in order to improve the prognosis.

scholarly journals 258. D-Dimer, Erythrocyte Sedimentation Rate, and C-Reactive Protein Sensitivity for PJI Diagnosis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Ayden Case ◽  
Lefko T Charalambous ◽  
Trevor Bowman ◽  
Ian Duensing ◽  
Edward Hendershot ◽  
...  
Keyword(s):  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Board Member ◽  
C Reactive Protein ◽  
Research Support ◽  
Educational Support ◽  
Material Support ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
D Dimer

Abstract Background Consensus criteria for the diagnosis of acute PJI now include D-dimer. Additionally, Erythrocyte Sedimentation Rate (ESR) is of questionable use in the diagnosis of acute PJI. There is scarce and contradicting evidence on the diagnostic value for these biomarkers, and further studies on larger cohorts are needed for validation. We sought to quantify the sensitivities of D-dimer and ESR compared to C-Reactive Protein (CRP) in the diagnosis of acute PJI at a tertiary referral center. Sensitivity Table for D-Dimer and ESR Methods An institutional database was queried for patients undergoing revision procedures for PJI after total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2014 to present. Patients were included if they had a PJI diagnosis code with subsequent revision procedure CPT codes and PICC line placement within 21 days of revision surgery. Patients with inflammatory arthropathies were excluded. Diagnostic labs, including CRP, ESR, and D-dimer, were collected within 90 days pre- and post-operatively and sensitivities for the diagnosis of PJI were calculated. Cutoff values included CRP &gt;1 mg/dL, ESR &gt;30 mm/hr and &gt;50 mm/hr, and D-dimer &gt;860 ng/mL. Results In total, 961 PJI patients were identified. Of those, 904 had ESR and CRP values collected, and 123 had ESR, CRP, and D-dimer collected. In the cohort of patients with ESR and CRP, 603 patients had elevated CRP, 554 had ESR &gt;30 mm/hr, and 379 had ESR &gt;50 mm/hr, corresponding to sensitivities of 66.7%, 61.3%, and 41.9%, respectively. In the cohort of patients with all three biomarkers, 113 had an elevated D-dimer, corresponding to a sensitivity of 91.9%. Conclusion In this cohort, CRP and ESR were of comparable sensitivity in diagnosing PJI. D-dimer was the most sensitive, but further pooled studies are needed to confirm this. Providers should continue to use this information in the context of other data and MSIS criteria to inform decision-making. Disclosures Thorsten Seyler, MD/PhD, Depuy Synthes (Other Financial or Material Support, Resident Educational Support)Extrel Therapeutics (Board Member, Shareholder)Heraeus Medical (Consultant)MiCare Path (Board Member, Shareholder)OREF (Grant/Research Support)Pattern health (Board Member)Restor3D (Other Financial or Material Support, Royalties)Smith+Nephew, Inc. (Grant/Research Support, Speaker’s Bureau)Stryker (Other Financial or Material Support, Resident Educational Support)Total Joint Orthopedics, Inc. (Consultant)Wolters Kluwer Health (Other Financial or Material Support, Royalties)Zimmer Biomet (Grant/Research Support) William Jiranek, MD, Depuy Synthes (Other Financial or Material Support, Royalty/Licensing)

scholarly journals Case Report of Multisystem Inflammatory Syndrome in a Child Related to COVID-19

2021 ◽  
Vol 20 (2) ◽  
pp. 89-92
Author(s):  
Faisal Ahmed ◽  
Hasan Zahid ◽  
Moinul Hasan ◽  
Anwar Hossain ◽  
Md Arman Zaid ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Dysfunction ◽  
Digestive System ◽  
Multiple Organ ◽  
C Reactive Protein ◽  
Paediatric Ward ◽  
Reactive Protein ◽  
Ankle Joints ◽  
Inflammatory Syndrome ◽  
D Dimer

Background : Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition that appears to be linked to Coronavirus Disease 2019 (COVID-19). Most children who become infected with the COVID-19 virus have only a mild illness. Aim of this study to evaluate the children who go on to develop MIS-C, some organs and tissues-such as the heart, lungs, blood vessels, kidneys, digestive system, brain, joints, skin or eyes -become severely inflamed. Case Report : 11 years old girl admitted in Paediatric Ward of in Imperial Hospital Chattogram on 12 July 2020 with the complains of fever, loose motion, rash in hands, body and legs, swelling of the wrist and ankle joints which were associated with anorexia, nausea , vomiting and bodyache. For this reason the child was evaluated. Conclusion : Clinical features in children have varied but predominantly include cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-Reactive Protein (CRP) Ferritin, D-dimer and Interleukin-6. MIS-C can lead to shock and multiple organ failure requiring intensive care. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 89-92

Clinical characteristics of COVID-19 patients (Latvia, Spring 2020)

2020 ◽  
Author(s):  
Ludmila Viksna ◽  
◽  
Oksana Kolesova ◽  
Aleksandrs Kolesovs ◽  
Ieva Vanaga ◽  
...  
Keyword(s):  
Blood Cells ◽  
Troponin T ◽  
Sodium Concentration ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Coagulation Tests ◽  
Damage Indicators ◽  
Prothrombin Index ◽  
D Dimer

Data include following variables: Demographics, epidemiological history, comorbidities, diagnosis, complications, and symptoms on admission to the hospital. Also, body’s temperature and SpO2. Blood cells: white cells count (WBC), neutrophils (Neu), lymphocytes (Ly), eosinophils (Eo) and monocytes (Mo), percentages of segmented and banded neutrophils, erythrocytes (RBC), platelet count (PLT), hemoglobin (Hb), and hematocrit (HCT); Inflammatory indicators: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); Tissue damage indicators: alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and troponin T (TnT); Electrolytes: potassium and sodium concentration; Renal function indicators: creatinine and glomerular filtration rate (GFR); Coagulation tests: D-dimer, prothrombin time, and prothrombin index on admission to the hospital.

scholarly journals Pediatric COVID-19 related myocarditis in multisystem inflammatory syndrome: A case report

2021 ◽  
Vol 61 (5) ◽  
pp. 283-6
Author(s):  
Ririe Fachrina Malisie
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Myocardial Injury ◽  
Acute Myocarditis ◽  
Multiple Organ ◽  
Shortness Of Breath ◽  
Unexpected Death ◽  
Clinical Presentations ◽  
Inflammatory Infiltrates ◽  
Inflammatory Syndrome

A number of coronavirus disease-19 (COVID-19)–related myocarditis cases have recently been reported. Myocarditis is an inflammatory disease of the heart characterized by inflammatory infiltrates and myocardial injury without an ischemic cause.1 While multiple etiologies exist, the major cause appears to be related to viral illnesses. Clinical presentations vary from asymptomatic to sudden unexpected death.2 Acute heart failure due to COVID-19-related acute myocarditis has been associated with multisystem inflammatory syndrome, mimicking Kawasaki disease. 3 Here, we report a case of a 1-month old girl with reactive anti-COVID–19 IgG, presenting with arrhythmia following the shortness of breath during hospitalization. Respiratory distress and myocarditis progressed to multiple organ failure and the patient died on her third day in the PICU.

scholarly journals Osteopontin as a biomarker for COVID-19 severity and multisystem inflammatory syndrome in children: A pilot study

2021 ◽  
pp. 153537022110468
Author(s):  
Andrew Reisner ◽  
Laura S Blackwell ◽  
Iqbal Sayeed ◽  
Hannah E Myers ◽  
Bushra Wali ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Case Definition ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Asymptomatic Children ◽  
Potential Biomarker ◽  
Residual Blood ◽  
Inflammatory Syndrome ◽  
Symptomatic Control

This study sought to evaluate the candidacy of plasma osteopontin (OPN) as a biomarker of COVID-19 severity and multisystem inflammatory condition in children (MIS-C) in children. A retrospective analysis of 26 children (0–21 years of age) admitted to Children’s Healthcare of Atlanta with a diagnosis of COVID-19 between March 17 and May 26, 2020 was undertaken. The patients were classified into three categories based on COVID-19 severity levels: asymptomatic or minimally symptomatic (control population, admitted for other non-COVID-19 conditions), mild/moderate, and severe COVID-19. A fourth category of children met the Centers for Disease Control and Prevention's case definition for MIS-C. Residual blood samples were analyzed for OPN, a marker of inflammation using commercial ELISA kits (R&D), and results were correlated with clinical data. This study demonstrates that OPN levels are significantly elevated in children hospitalized with moderate and severe COVID-19 and MIS-C compared to OPN levels in mild/asymptomatic children. Further, OPN differentiated among clinical levels of severity in COVID-19, while other inflammatory markers including maximum erythrocyte sedimentation rate, C-reactive protein and ferritin, minimum lymphocyte and platelet counts, soluble interleukin-2R, and interleukin-6 did not. We conclude OPN is a potential biomarker of COVID-19 severity and MIS-C in children that may have future clinical utility. The specificity and positive predictive value of this marker for COVID-19 and MIS-C are areas for future larger prospective research studies.

scholarly journals Relationship between ECG Findings and Serum Biomarkers in COVID-19 Patients

2021 ◽  
Vol 7 (3) ◽  
pp. 64-69
Author(s):  
Gökhan Perincek ◽  
Muammer Karakayalı ◽  
Sema Avcı
Keyword(s):  
Lymphocyte Count ◽  
Myocardial Injury ◽  
Troponin T ◽  
P Wave ◽  
Rt Pcr ◽  
C Reactive Protein ◽  
Premature Ventricular Contractions ◽  
Reactive Protein ◽  
Fragmented Qrs ◽  
D Dimer

Abstract Background and aim: The aim of this study was to evaluate the relationship between ECG findings and blood parameters indicative of inflammation and myocardial injury in COVID-19 patients. Methods: The study included 159 females and 194 males. Demographics, ECG findings (axis, rhythm, branch block, ST- and T-wave changes, premature ventricular contractions, early repolarization, S1Q3T3, fragmented QRS [fQRS], rate, PR, QRS, QT interval, QTc, P-wave dispersion) and albumin, D-dimer, ferritin, pro-BNP, procalcitonin, protein, troponin T, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) were recorded. Results: In the study, 45% of the cases were female and 55% were male. The mean age of the included patients was 45.7 ± 24.4 years. The most frequent comorbidities were chronic obstructive pulmonary disease (COPD) and hypertension (HT) in both groups. The incidence of fQRS on the 1st day was significantly higher in patients with negative COVID-19 test (23% for positive RT-PCR versus 35.6% for negative RT-PCR, p = 0.016). QTc values on the 3rd and 5th day were significantly higher in patients with negative RT-PCR (p = 0.045 and p = 0.042, respectively). Albumin and procalcitonin were significantly higher in patients with positive COVID-19 test results (p = 0.018 and p <0.001, respectively). Patients with fragmented QRS presented significantly lower serum albumin (40.62 ± 4.73 g/L vs. 42.92 ± 3.72 g/L, p = 0.01), and protein levels (p = 0.02), as well as lower lymphocyte count, and significantly higher levels of C-reactive protein (47.01 ± 65.01 mg/L vs. 24.55 ± 44.17 mg/L, p = 0.001), D-dimer (p = 0.009), neutrophil count, pro-BNP (p = 0.004), troponin T (p <0.001), NRL and CAR (1.28 ± 1.83 versus 0.6 ± 1.11, p <0.001). Conclusion: Patients with COVID-19 infection presented significantly higher levels of C-reactive protein, D-dimer, neutrophil, pro-BNP, procalcitonin, troponin T, NLR, and CAR, and significantly lower levels of albumin, lymphocyte count, and serum proteins, indicating the level of inflammation and its relationship with myocardial injury. Further follow-up studies are required, on larger patient sets, for the development of risk prediction tools in COVID-19 patients.

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