Pediatric multisystem SARS COV2 with versus without cardiac involvement: a multicenter study from Latin America

Pignatelli, Ricardo; Antona, Clara Vazquez; Rivera, Ivan Romero; Zenteno, Patricia Alvarez; Acosta, Yanet Toribio; Huertas-Quiñones, Manuel; Murillo, Carlos Alvarez; Torres, Franklin Mendoza; Cabalin, Carlos Fernandez; Camacho, Ana Galván; Pérez, Alex Alcántara; Lombardi, Ana Braga; Soares, Andressa Mussi; Garcia, Carolina Torres; Borges, Cibelle Teixeira; Villalba, Claudia Natalia; Lechado, Cristhian Ramírez; Dias, Deborah Trevisan; Morales, Diana Aravena; Copete, Elizabeth Mora; Goldenberg, Guillermo Larios; Salazar, Jahaira Sussety; Moreira, Jessica Alchundia; Asakura, Junko; Sabando, Karla Solórzano; Branco, Klebia Castello; Rosas, Lida Toro; Duarte, Magna Pereira; Carbajal, María Jiménez; Hernandez, Martha Rubio; Martínez, Moisés Mier; Echeverría, Nancy Garay; Caneva, Olga Maza; Sepulveda, Patricia Romero; Díaz, Paulina Agurto; Plúas, Ruth Rugel; Alvarado, Theo Contreras; Faundes, Lorena Tapia; Diaz, Yeny Briones; Zachariah, Justin P.

Latin America (LATAM) children offer special insight into Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) due to high-risk race/ethnicity, variability in medical resources, diverse socioeconomic background, and numerous involved organ systems. This multinational study of LATAM youth examined the distinguishing features of acute or late multisystem SARS COV2 with versus without cardiac involvement. A consecutive sample of youth 0–18 years old (N = 98;50% male) presenting with multisystem SARS COV2 to 32 centers in 10 Latin American countries participating in a pediatric cardiac multi-imaging society were grouped as with versus without cardiac involvement, defined as abnormal echocardiographic findings or arrhythmia. Collected clinical data were analyzed by Student’s t-test or Fisher’s exact test. Cardiac (N = 48, 50% male) versus no cardiac (N = 50, 50% male) were similar in age; weight; nonrespiratory symptoms; and medical history. The cardiac group had 1 death and symptoms including coronary artery dilation, ejection fraction <50%, pericardial effusion, peripheral edema, arrhythmia, and pulmonary artery thrombus. The cardiac group had higher risk of ICU admission (77% vs 54%, p = 0.02); invasive ventilation (23% vs 4%,p = 0.007); vasoactive infusions (27% vs 4%, p = 0.002); prominent respiratory symptoms (60% vs 36%, p < 0.03); abnormal chest imaging (69% vs 34%, p = 0.001); troponin (33% vs 12%, p = 0.01); alanine aminotransferase (33% vs 12%, p = 0.02); and thrombocytopenia (46% vs 22%, p = 0.02). Receiver operating curve analysis showed that abnormal laboratories had 94% sensitivity and 98% negative predictive value on the need for ICU interventions. Conclusion: In LATAM children with multisystem SARS COV2, cardiac involvement was prevalent. Cardiac involvement was more likely to require ICU interventions, certain abnormal labs, and respiratory involvement. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00431-021-04052-9.