Distinguishing Between Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children and the Kawasaki Disease: Development of Preliminary Criteria Based on the Data of the Retrospective Multicenter Cohort Study

Objectives: Diagnostic between multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) and Kawasaki disease (KD) can make difficulties due to many similarities. Our study aimed to create a Kawasaki/MIS-C differentiation score (KMDscore) allowing discrimination of MIS-C and KD.Study design: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about MIS-C (n = 72) and KD (n = 147). The variables allowed to discriminate both conditions used to construct and validate the diagnostic score called the KMDscore.Results: Patients with MIS-C were older, had earlier admission to the hospital, had a shorter time before fever resolution, two times frequently had signs of GI and CNS involvement observed, and had more impressive thrombocytopenia, higher level of CRP, ferritin, ALT, AST, LDH, creatinine, triglycerides, troponin, and D-dimer compared to KD patients. Respiratory signs in MIS-C were presented with pleuritis, acute respiratory distress syndrome, oxygen dependency, lung infiltration, and ground-glass opacities in CT. The heart involvement with fast progression of myocarditis provided the severity of MIS-C and ICU admission due to 12 times higher arterial hypotension or shock and required cardiotonic. No differences in the frequency of CA lesions were seen in the majority of cases. Five criteria, CRP >11 mg/dl (18 points), D-dimer >607 ng/ml (27 points), age >5 years (30 points), thrombocytopenia (25 points), and GI involvement (28 points), were included in the KMDscore. The summa >55 points allowed to discriminate MIS-C from KD with a sensitivity of 87.5% and specificity of 89.1%.Conclusion: The KMDscore can be used to differentiate the diagnostic of MIS-C from KD.

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Immune reconstitution inflammatory syndrome in a large multicenter cohort study: case definition and comparability

Expert Review of Anti-infective Therapy ◽

10.1586/eri.12.62 ◽

2012 ◽

Vol 10 (7) ◽

pp. 737-741 ◽

Cited By ~ 6

Author(s):

Graeme Meintjes ◽

Andrew Boulle

Keyword(s):

Cohort Study ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Case Definition ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Study Case ◽

Inflammatory Syndrome

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D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2021.02.003 ◽

2021 ◽

Author(s):

Richard Chocron ◽

Baptiste Duceau ◽

Nicolas Gendron ◽

Nacim Ezzouhairi ◽

Lina Khider ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Hospital Admission ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

D Dimer

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Validity and clinical utility of the simplified Wells rule for assessing clinical probability for the exclusion of pulmonary embolism

Thrombosis and Haemostasis ◽

10.1160/th08-07-0444 ◽

2009 ◽

Vol 101 (01) ◽

pp. 197-200 ◽

Cited By ~ 45

Author(s):

Nadine Gibson ◽

Victor Gerdes ◽

Harry Büller ◽

Philip Wells ◽

Arnaud Perrier ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Venous Thromboembolism ◽

Clinical Utility ◽

Multicenter Cohort Study ◽

Clinical Probability ◽

Multicenter Cohort ◽

Wells Rule ◽

D Dimer

SummaryThe recently introduced simplified Wells rule for the exclusion of pulmonary embolism (PE) assigns only one point to the seven variables of the original Wells rule. This study was performed to independently validate the simplified Wells rule for the exclusion of PE. We retrospectively calculated the prevalence of PE in the “unlikely” probability categories of the original Wells (cut-off ≤4) and the simplified Wells rule (cut-off ≤1) in 922 consecutive patients with clinically suspected PE from a multicenter cohort study. We compared the three-month incidence of venous thromboembolism (VTE) in patients with an unlikely probability and a normal D-dimer test using both scores, and the proportion of patients with this combination (clinical utility). The proportion of patients categorized as PE “unlikely” was similar using the original (78%) and the simplified (70%) Wells rule. The prevalence of PE was 13% (95% confidence interval [CI], 11–16%) and 12% (95%CI, 9.7–15%) for the original Wells and simplified Wells “unlikely” categories, respectively. None of the patients with PE “unlikely” and a normal D-dimer test experienced VTE during three-month follow-up. The proportions of patients in whom further tests could safely be withheld based on PE “unlikely” and a normal D-dimer test was 28% (95%CI, 25–31%) using the original and 26% (95%CI, 24–29%) using the simplified Wells rule. In this external retrospective validation study, the simplified Wells rule appeared to be safe and clinically useful, although prospective validation remains necessary. Simplification of the Wells rule may enhance the applicability.

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ECMO Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study

10.21203/rs.3.rs-53559/v1 ◽

2020 ◽

Author(s):

Jing Fang ◽

Yue Chen ◽

Ming Hu ◽

Rui Li ◽

Juanjuan Qin ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Cox Model ◽

Multicenter Cohort Study ◽

Mixed Effect ◽

Icu Admission ◽

Multicenter Cohort ◽

All Cause Mortality ◽

Ecmo Therapy ◽

D Dimer

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to surges in the demand for extracorporeal membrane oxygenation (ECMO) therapy. However, little in-depth evidence is known about the application of ECMO therapy in COVID-19 patients. Methods This retrospective multicenter cohort study included 88 patients who had been diagnosed with COVID-19 and received ECMO therapy at seven designated hospitals in Wuhan, China. The clinical characteristics, laboratory examinations, treatments, and outcomes were extracted from electronic medical records and compared between weaned and non-weaned ECMO patients. The patients were followed until June 30, 2020. Logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. The primary endpoint, 120-day all-cause mortality after intensive care unit (ICU) admission during hospitalization, was compared using a mixed-effect Cox model. Results Of 88 patients who received ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. A lymphocyte count ≤ 0.5 × 109/L and D-dimer concentration > 4 × the upper limit of normal at ICU admission, a peak PaCO2 > 60 mmHg at 24 hours before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group, as compared with the IMV-only group. Conclusion Patients in Wuhan who received ECMO therapy had a relatively high mortality rate. This outcome may be largely attributable to resource-limited situations during the COVID-19 outbreak. In future, the presence of lymphocytopenia and higher D-dimer concentrations at ICU admission and hypercapnia at 24 hours before ECMO initiation could help to identify patients with a poor prognosis. Moreover, tracheotomy could facilitate weaning from ECMO. Despite the high mortality, ECMO was associated with improved outcomes relative to IMV-only therapy in critically ill COVID-19 patients.

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