Multi-Inflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective

Background Multi-inflammatory syndrome in children (MIS-C) is a novel and rare inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school-age children. Reports in the past year have suggested a multi-system pathophysiology characterized by hyperinflammation, gastrointestinal distress, and cardiovascular complications. Clinical laboratory investigations, including routine blood testing for inflammatory (e.g., CRP, ferritin) and cardiac (e.g., troponin, brain natriuretic peptides) markers have provided insight into potential drivers of disease pathogenesis, highlighting the role of the laboratory in the differential diagnosis of patients presenting with similar conditions (e.g., Kawasaki Disease, Macrophage Activating Syndrome). Content While few studies have applied high-dimensional immune profiling to further characterize underlying MIS-C pathophysiology, much remains unknown regarding predisposing risk factors, etiology, and long-term impact of disease onset. The extent of autoimmune involvement is also unclear. In the current review, we summarize and critically evaluate available literature on potential pathogenic mechanisms underlying MIS-C onset and discuss the current and anticipated value of various laboratory testing paradigms in MIS-C diagnosis and monitoring. Summary From initial reports, it is clear that MIS-C has unique inflammatory signatures involving both adaptive and innate systems. Certain cytokines, inflammatory markers, and cardiac markers assist in the differentiation of MIS-C from other hyperinflammatory conditions. However, there are still major gaps in our understanding of MIS-C pathogenesis, including T cell, B cell, and innate response. It is essential that researchers not only continue to decipher initial pathogenesis but also monitor long-term health outcomes, particularly given observed presence of circulating autoantibodies with unknown impact.

Retrospective analysis of electronic health records of patients with heart failure: the first Russian experience

The article presents the first experience of analyzing the treatment quality of hospitalized patients with heart failure based on electronic health records (EHR). We analyzed EHR of patients hospitalized in three large hospitals in Kirov. The results of the analysis indicated insufficient detailed information in the EHR, which complicates analyzing the accuracy of diagnosis and therapy quality. In particular, attention is drawn to the disproportionate number of patients with heart failure with reduced and preserved ejection fractionю This, apparently, is due to the low prevalence of assessing brain natriuretic peptides and conducting Doppler echocardiography. A separate part of the analysis is devoted to assessing the therapy quality in patients with concomitant diabetes. Despite the study limitations, the presented results can be useful for improving the quality of EHR filling for performing further observational clinical trials.

Stroke occurrence in patients with STEMI: does BNP help to predict?

Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction Although brain natriuretic peptides (BNP) has been primarily identified in brain tissue, its clinical application is primarily related to cardiac disease, namely heart failure. The current information on this natriuretic peptide in cerebrovascular disease is limited, however some studies performed showed an acute elevation of BNP during the acute phase of ischemic stroke. Objective Evaluation of prognostic value of BNP in the occurrence of in-hospital ischemic stroke in patients admitted with ST elevation myocardial infarction (STEMI). Material and methods Retrospective analysis of patients´ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into two groups: group 1 – patients who suffered an ischemic stroke (0.8%) and group 2 – without stroke (99.2%). Demographic and clinical characteristics were compared. A logistic regression was performed to evaluate prognostic value of BNP in the occurrence of in-hospital stroke and cardiovascular events. Results Admitted 1650 patients with STEMI. There was no statistically significant difference between mean age in both groups (mean age 64 ± 13 years, p 0.122) and most patients were male (75.4%). A higher percentage of group 1 patients had a previous diagnosis of stroke/ transitory ischemic accident (28.6 vs 5.4%, p 0.006) but there was no significant differences regarding the percentages of previous arterial hypertension, diabetes, dyslipidaemia neither peripheral vascular disease. Mean values of BNP at admission were higher in group 1: 839 ± 1088 vs 333 ± 639 pg/ml (p 0.04). All patients were submitted to coronary angiography, without evidence of significant differences regarding severity of coronary disease. In group 1 patients mean left ventricle ejection fraction (LVEF) during hospitalization was lower: 43 ± 11 vs 53 ± 13 %, p 0.005. Logistic regression identified as prognostic factors of in-hospital ischemic stroke: previous stroke/ transitory ischemic accident (p 0.007), dementia (p 0.005) or thoracic pain at STEMI presentation (p 0.005). Although patients with higher levels of BNP had suffered more stroke (0.5% in group with BNP < 100pg/ml; 0.6% in group with 100 ≤ BNP < 400 pg/ml; and 2.0% in group with BNP ≥ 400 pg/ml), BNP did not show to be predictor of stroke occurrence in this context (p 0.862). Conclusion Although patients with higher levels of BNP had suffered more stroke, BNP did not show to be predictor of stroke occurrence in patients admitted with STEMI.

Predictive Role of BNP/NT-proBNP in Non-Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation: An Updated Systematic Review

: Atrial Fibrillation (AF) is a growing public health issue, associated with significant morbidity and mortality. In addition to pharmacological therapy, catheter ablation is an effective strategy in restoring and maintaining sinus rhythm. However, ablation is not without risk, and AF recurs in a significant proportion of patients. Non-invasive, easily accessible markers or indices that could stratify patients depending on the likelihood of a successful outcome following ablation would allow us to select the most appropriate patients for the procedure, reducing the AF recurrence rate and exposure to potentially life-threatening risks. : There has been much attention paid to Brain Natriuretic Peptide (BNP) and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP) as possible predictive markers of successful ablation. Several studies have demonstrated an association between higher pre-ablation levels of these peptides, and a greater likelihood of AF recurrence. Therefore, there may be a role for measuring brain natriuretic peptides levels when selecting patients for catheter ablation.