Doctors have identified a group of blood compounds that could help reveal which children are most at risk for developing a rare but potentially fatal immune response to the coronavirus.
The new syndrome appeared last month after London hospitals admitted a number of children to intensive care units with symptoms that looked like toxic shock mixed with an inflammatory disorder known as Kawasaki disease .
Hospitals around the world have since reported hundreds of similar cases that many doctors believe are due to an over-reaction of the immune system to the virus, sometimes weeks after infection.
About 100 children in Britain have been treated for the disease. Many have been admitted with persistent fever, rashes, abdominal pain, and cold hands or feet. At least two children in the UK died of the disorder, including an eight-month-old baby at Derlyford Hospital in Plymouth in April.
Researchers at Imperial College London analyzed the blood of some of the sickest children and found that they had high levels of five compounds that can be measured by routine testing. Two of the compounds, ferritin and C-reactive protein or CRP, are common blood markers for inflammation. The others are related to heart damage and blood clotting, namely troponin, BNP and the so-called “D-dimers”.
“We know these markers are present in very sick patients and at lower levels in some patients with normal Kawasaki disease,” said Michael Levin, Imperial’s professor of pediatrics and international child health.
“We think they can help us decide which children are at risk of developing heart failure. Essentially, we use blood markers to try to select the children we need to go from district hospitals to specialty centers, and then to intensive care units if necessary. “
More research is needed to determine if the markers are reliable. If so, doctors could potentially identify the children most at risk for the condition with a simple blood test.
To investigate further, researchers have received permission from England’s chief medical officer, Professor Chris Whitty, to recruit children into a European-funded trial called Diamonds, which was already underway to study the disorders inflammatory. Doctors in the UK and various European hospitals are now collecting blood samples for the study to find out which markers can help them predict the severity of the disease and understand the genetics of the disease.
“This is a rapidly changing situation and we desperately need to learn to manage it because we are now seeing quite a large number of children admitted to district hospitals everywhere,” said Levin.
“What we don’t know when we see a child for the first time or hear about it if they are in another hospital is which children will improve by themselves and who will progress of Kawasaki and are therefore at risk of contracting aneurysms of the coronary arteries, and which are the small number that will progress to a multi-organ failure. “
The disease, called pediatric inflammatory multisystem syndrome, looks like a mixture of toxic shock and Kawasaki disease, the latter of which affects children massively. The disease causes inflammation of the blood vessels and, in some cases, attacks the heart. The most serious complications are coronary aneurysms which can be fatal when they clot. Doctors usually respond quickly with anti-inflammatory drugs or immunosuppressive drugs.
Doctors don’t have time to run a formal test to find out which treatments work best. Instead, plans have been made for an international database that they will use to enter anonymous information about the children in their care, including the results of blood tests and the treatments that will be administered at which level. moment. “It is not as good as a randomized trial, but it is the second best thing in a pandemic. Because the numbers will be so large, it could give us a signal about the best treatments, “said Levin.
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said it was too early to know how useful blood biomarkers could be in stratifying children with the new inflammatory disease.
“This peak will disappear as the Covid peak ends and we are already seeing it,” said Viner. “But if Covid is going to be with us for a while, and there will be an increase in Covid cases, we will see more of those cases.” So there is an urgent need to find ways to quickly identify children who may be suffering from it, as opposed to a child who has just had a fever, so that biomarkers could be exceptionally useful in the long run. “
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