| Capone et al.,[12] |
Marked inflammation , 48% had coronary abnormalities, (15% had coronary artery aneurysm and 9% had coronary artery dilatation). |
79% of patients were admitted ICU, No death |
18% required mechanical ventilation, most patients exhibited rapid clinical improvement, Mild cardiac dysfunction was still present at time of discharge only in 9 out of 19 who had impaired function during hospitalization, Median length of hospitalization=4 days. |
| Whittaker et al.,[13] |
All patients had evidence of a marked inflammatory state (C-reactive protein, neutrophilia, and ferritin), tropoinin conc were elevated in 68%, NT-proBNP in 83%, evidence of left ventricular dysfunction on ECG 62% of the 29 children developed shock |
50% of patients were admitted to ICU One death |
22% only required supportive care, 22% developed acute kidney injury, shock requiring inotropic support 47%, and mechanical ventilation (43%), 2 children required extracorporeal membrane oxygenation for severe myocardial dysfunction |
| Dufort et al.,[14] |
66% had lymphopenia, 74 out of 82 (90%) had elevated proBNP levels, 63 out of 89 (71%) had elevated troponin, 100% had elevated C-reactive protein levels, 86 out of 94 (91%) had elevated D-dimer levels |
80% of patients were admitted to ICU 2% died (none of them received IVIG, Steroids, or immune- modulators) |
10% received mechanical ventilation 53% evidence of myocarditis, 52% had some degree of ventricular dysfunction, 32% had pericardial effusion, and 9% had a documented coronary-artery-aneurysm, 36% had KD or KD like syndrome, Median length of hospitalization stay was 6 days On date of publishing 77% of patients were discharged |
| Pouletty et al.,[15] |
Ten patients (62%) fulfilled the American Heart Association (AHA) definition of complete KD. Inflammatory biomarkers were highly elevated in all patients. Acute renal failure was observed in nine cases (56%), Serum cytokines were elevated in tested patients |
43% were admitted to the ICU No death |
43% patients required fluid resuscitation. Respiratory assistance for ICU patients included oxygen therapy (n=4, 57%) for a median time of 2 days, non-invasive ventilation (n=3, 42%) or invasive ventilation (n=2, 28%). Cardiac ultrasound was abnormal and Myocardial enzymes were elevated in 11 patients. |
| Belhadjer et al.,[16] |
All presented with a severe inflammatory state Inflammatory markers were suggestive of cytokine storm (C-reactive protein, D-dimer, and interleukin. Mild-moderate elevation in troponin, NT-proBNP or BNP elevation was present in all children. 10/35 depressed left ventricular systolic function <30%. 17% dilatation of coronary arteries |
83% were admitted to the ICU directly and 17% were transferred to ICU after one day from admission No death |
28% required mechanical circulatory assistance with ECMO, 66% required invasive mechanical ventilator support 80% were in cardiogenic shock required inotropic support & left ventricular function was restored in 25/35 patients of those discharged from the ICU, all patients treated with ECMO were successfully weaned. Two-thirds had respiratory distress requiring invasive mechanical ventilator support. 28/35 discharged. Seven patients were still in the hospital or with LV dysfunction. |
| Toubiana et al.,[17] |
High level of inflammatory markers. Echocardiography detected coronary artery abnormalities in eight (38%). Transient kidney failure was observed in 11 (52%) patients. local patchy shadowing, and interstitial abnormalities were present in eight (44%) patients. Moderate increases in serum alanine transaminases and g-glutamyltransferase levels occurred in 62% and 76% of patients, respectively high sensitivity cardiac troponin 81%. B-type natriuretic peptide 78%. All patients had high level of inflammatory markers. 81% had lymphopaenia 95% increased D-dimer. 81% increased tropoinin. 78% increased B-type NP |
81% of patients required ICU No death |
Outcome was favorable in all patients, Moderate coronary artery dilations were detected in 24% of patients during hospital stay, all patients were discharged home Median (range) length of hospital stay (days) 8 (5-17). Fluid resuscitation 11 (52%) Mechanical ventilation 11 (52%). |
| Verdoni et al.,[18] |
Increased inflammatory markers ESR, CRP, and ferritin Full blood count showed a mean white cell count of 10.8¥109 per L (SD 6.1), with increased neutrophil percentage in eight patients lymphopenia in eight patients, and thrombocytopenia in eight patients. Hyponatraemia was observed in eight patients and a slight increase in transaminases was recorded in seven patients (aspartate aminotransferase, alanine aminotransferase, Hypertriglyceridaemia was shown in seven (87%) of eight tested patients in group 2, fibrinogen was high in nine (90%) of 10 patients as was D-dimer in eight (80%) of 10 patients. Laboratory criteria predicted intravenous immunoglobulin-resistance in seven (70%) of 10 patients. MAS was diagnosed in five (50%) of 10 patients. Troponin I was elevated in five (55%) of nine tested patients. creatine phosphokinase in one (10%) of 10 patients, and proBNP in all 10 patients. |
Most patients (148 [80%]) were cared for in an intensive care unit 4 (2%) had died |
Inotropic treatment in 20%, Response to treatment 100%. (48%) receiving vasoactive support. Most patients (170 [91%]) had at least one echocardiogram. Coronary-artery aneurysms identified on the basis of a z score of 2.5 or higher in the left anterior descending or right coronary artery were documented in 8% of the patients (15 of 186) and in 9% of those with echocardiograms (15 of 170). Respiratory insufficiency or failure occurred in 109 patients (59%). 85 (78%) of these patients had no underlying respiratory conditions. Overall, 37 patients (20%) received invasive mechanical ventilation and 32 (17%) received noninvasive mechanical ventilation. Most patients (132 [71%]) had involvement of at least four organ systems. The most commonly involved organ systems were the gastrointestinal (171 [92%]), cardiovascular (149 [80%]), hematologic (142 [76%]), mucocutaneous (137 [74%]), and respiratory (131 [70%]) systems. 37 (20%) received invasive mechanical ventilation. Eight patients (4%) received extracorporeal membrane oxygenation (ECMO) support. A total of 130 patients (70%) had been discharged alive, 52 (28%) were still hospitalized. The median length of hospitalization was 7 days among the patients who were discharged alive and 5 days (range, 2 to 5) among those who died. The 4 patients who died were 10 to 16 years of age; 2 of the patients had diagnoses of underlying conditions, and 3 received ECMO support |
| Feldstein et al.,[19] |
92% elevation in at least four biomarker indicating inflammation (73% BNP, 50% troponin). Respiratory failure or insufficiency 59%, 92% had 4 elevated inflammatory markers (Majority had elevated ESR, C-reactive protein, lymphocytopenia, neutrophilia, ferritin,....) |
Most patients (148 [80%]) were cared for in an intensive care unit and 4 (2%) had died |
37 (20%) received invasive mechanical ventilation. Eight patients (4%) received ECMO support. a total of 130 patients (70%) had been discharged alive, 52 (28%) were still hospitalized, the median length of hospitalization was 7 days (interquartile range, 4 to 10) among the patients who were discharged alive and 5 days (range, 2 to 5) among those who died |
| Ramcharan et al.,[20] |
Elevated inflammatory markers. 100% troponin, 7 had chest abnormalities including pleural effusion, consolidation, cardiomegaly. Fourteen patients had chest radiographs; 7 were normal, 7 had abnormalities including pleural effusions (5), consolidation (3), and cardiomegaly (2). Six patients had abdominal ultrasound due to persistent gastrointestinal symptoms, showing no abnormalities. During their admission, two patients had non-coronary CT angiograms and one had a MRI whole body, due to persisting inflammation despite treatment, all of which showed no evidence of vasculitis. 60% had cardiac abnormalities |
67% of patients needed ICU with a median stay of 4 days There were no deaths. |
8 (53%) needed respiratory support, half of them required mechanical ventilation and others required high-flow nasal cannula support, median hospital stay 12 days. Ten patients (67%) needed fluid resuscitation. Nine required epinephrine to support LV dysfunction. Median inpatient stay was 12 days (IQR 9-13 days). All 15 patients were discharged home clinically well with normal/improving biochemical and cardiac parameters. |
| Miller et al.,[21] |
Overall, the majority of cases at admission had markedly elevated inflammatory markers. ESR CRP and mildly decreased albumin Transaminases were elevated in 52.3% and lipase was elevated >3 times. Upper limit of normal in only one patient. Findings included mesenteric adenitis (n=2), biliary sludge or acalculous cholecystitis (n=6), and ascites (n=6). In three patients, US or MRI revealed bowel wall thickening (n=3), Of these patients, one had intense RLQ abdominal pain, fever and rash with MRI findings of severe concentric mural thickening, edema, and hyper-enhancement of a short segment of terminal ileum with extensive mesenteric fat edema, as well as similar mural thickening in the rectosigmoid colon |
No death |
Intubation 2.3%, one required renal replacement therapy. 2.3%, Discharged on publishing 97.7%. Only 25% required supplemental oxygen and one was intubated. |
| Riollano-Cruz et al.,[22] |
Elevated inflammatory markers in all patients, including 15 (100%) with elevated CRP and D-dimer, and 13 (87%) with elevated ferritin levels and 14 (93%) ESR. Levels of procalcitonin were checked in 13 patients and were elevated in 9 (60%) cases. At admission, lymphopenia was present in 13 (87%) patients, thrombocytopenia in 6 (40%), hypoalbuminemia in 8 (53%), and elevated fibrinogen in 14 (93%) patients. 100% interleukin-6, and interleukin 8. And 87% severe cardiac involvement. The most common findings Four (27%) patients presented with only depressed left ventricular function, and 3 (20%) with depressed biventricular function. Three patients presented with coronary artery abnormalities, including one patient with dilation and 2 (13%) with ectasia. One patient had ventricular tachycardia and ventricular ectopy, and another one had diffuse ST elevations on ECG. |
14 patients needed ICU One death required ECMO |
20% required intubation and mechanical ventilation., One patient required an intra-aortic balloon pump to treat cardiogenic shock, all except one were discharged, none required mechanical circulatory support, and one patient required renal replacement therapy. Three patients (20%) required intubation and mechanical ventilation, and an additional 5 (33%) patients required noninvasive mechanical ventilation. The child who died required ECMO during the nine days of admission. Eight (53%) patients needed vasopressor and vasoactive therapy, and one patient required an intra-aortic balloon pump to treat cardiogenic shock. Nine had gradual normalization of D-dimer, BNP, and troponin levels during admission. Thirteen remained admitted for a range of 6-13 days (mean 8 days) and have had continued improvement in inflammatory parameters upon outpatient follow-up. One patient expired on day nine after admission and one remains admitted. |
| Cheung et al.,[23] |
All had elevated inflammatory markers (lymphopenia 71%, elevated troponin 82%, NT proBNP 100%). ECG showed nonspecific abnormalities |
88% of patients were admitted to the ICU No death |
Most patients had improved function on follow-up echocardiogram. One patient had a medium-sized aneurysm of the left anterior descending coronary artery. Length of hospitalization 3-18 (7.1) days, All patients discharged home, vasoactive support in 59% |
| Belot et al.,[24] |
KLD and myocarditis were the most prevalent clinical features and were associated with 61% and 70% of the cases, respectively. Seritis and features of MAS were also overrepresented with a frequency of 22% and 23%. |
Critical care support was required in 67% of cases one death |
73% of the patients who were admitted to the intensive care unit required vasopressors and 43% required mechanical ventilation. |
| ICU: Intensive care unit; SARS-CoV-2: Severe acute respiratory syndrome-coronavirus 2; KD: Kawasaki disease; ECMO: Extracorporeal membrane oxygenation; BNP: B-type natriuretic peptide; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; SD: Standard deviation; LV: Left ventricular; IQR: Interquartile range; US: Ultrasound; MRI: Magnetic resonance imaging; RLQ: Right lower quadrant; ECG: Electrocardiogram; KLD: Kawasaki like disease; MAS: Macrophage activation syndrome. |
