165 - CARDIOVASCULAR FINDINGS IN PEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME FROM A PEDIATRIC CENTER IN MEXICO CITY

Background

A new clinical syndrome, similar to Kawasaki disease, emerged in late 2020 during the SARS-CoV-2 pandemic, designated as Pediatric Inflammatory Multisystem Syndrome (PIMS). Its diagnosis and cardiac assessment have been a challenge in recent years.

Objective

To determine the cardiovascular alterations in patients diagnosed with PIMS (myocarditis, coronary lesions, ventricular dysfunction and shock) and to assess serum inflammatory markers and cardiac biomarkers to identify severity risk factors.

Methods

Retrospective, cross-sectional, and analytical study of patients diagnosed with PIMS at the Instituto Nacional de Pediatría in Mexico City, Mexico from April 2020 to January 2023. Patients were divided into two groups for statistical analysis: those without shock and those with shock.

Results

During the study period, 101 patients were diagnosed with PIMS. Males predominated with a male-to-female ratio of 1.3:1. Patients without shock presented at a younger age compared to those with shock (74.41 months (±54.22) vs 109 months (±64.04), (p < 0.020)); patients with shock also had more days of hospital stay (p < 0.0001) and lower saturation levels (p < 0.023). A significant correlation was demonstrated between the shock state and thrombocytopenia, as well as higher values of CRP, PCT, ESR, ferritin, troponin, and NT-ProBNP. (Table 1)

The increase NT-ProBNP levels was associated with mild and moderate ventricular dysfunction (p < 0.001). Patients with mild and moderate dysfunction were found to have higher NT-ProBNP values, and severe dysfunction was likely not evident due to higher mortality. (Table 2, Figure 1). Patients without shock exhibited more coronary lesions and better ventricular function compared to the shock group (15.1% vs 7% with coronary lesions). Overall mortality was higher compared to the literature, especially in patients with shock (p < 0.002).

Conclusions:
Identifying clinical and cardiovascular complications in PIMS facilitates the identification of patients with risk factors for increased dysfunction and mortality. It was determined that the elevation of acute-phase reactants, as well as cardiac enzymes, plays a fundamental role in ventricular dysfunction and disease outcomes.