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Background: Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods: This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results: Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion: Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.
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Introducción: El síndrome de Kasabach Merritt (SKM) es poco frecuente, tiene una alta mortalidad y se caracteriza por una lesión vascular de crecimiento rápido, asociado a coagulopatía de consumo y trombocitopenia. Materiales y métodos: revisión de literatura actual confrontando con artículos de revisiones de temas en búsqueda electrónica en bases de datos de RIMA, MEDLINE, PUBMED, MEDSCAPE, de 1940 a 2017. Resultados Se describe un caso clínico de un niño de 10 meses de edad con Síndrome de Kasabach Merrit sucedido en el Hospital Infantil Napoleón Franco Pareja (HINFP) Conclusiones El síndrome Kasabach-Merritt es una entidad poco frecuente, su diagnóstico inicia desde la sospecha clínica, que incluye al examen físico el hallazgo de un hemangioma acompañado de trombocitopenia y coagulopatía. El manejo no está pautado, se dispone de corticoide como terapia de inicio, interferón, antineoplásico, radioterapia o cirugía, y su pronóstico va a depender de la resolución pronta.
Introduction: The Kasabach-Merritt syndrome (SKM) is rare, has a high mortality and is characterized by a vascular lesion of rapid growth, associated with coagulopathy of consumption and thrombocytopenia. Materials and methods: review of current literature in comparison with articles of reviews of subjects in electronic search in databases of RIMA, MEDLINE, PUB-MED, MEDSCAPE, from 1940 to 2017. Results A clinical case of a 10-month-old child is described. of age with Kasabach Merrit syndrome occurred at the Napoleon Franco Franco Children's Hospital (HINFP) Conclusions The Kasabach-Merritt syndrome is a rare entity, its diagnosis starts from the clinical suspicion, which includes the physical examination the finding of a hemangioma accompanied by thrombocytopenia and coagulopathy. The management is not scheduled, corticoid is available as start therapy, interferon, antineoplastic, radiotherapy or surgery, and its prognosis will depend on the prompt resolution.
