New research helps identify treatment plans for patients diagnosed with PIMS-TS

A new study authored by Royal Brompton Hospital paediatric cardiology consultants, Professor Alain Fraisse and Dr Carles Bautista, in collaboration with the infectious disease department at St Mary’s Hospital (part of Imperial College Healthcare NHS Trust) has been published in the journal Pediatrics. The study will help clinicians to identify which patients with a new syndrome, called paediatric multisystem inflammatory syndrome (PIMS-TS), will go on to become very sick and therefore what treatment is best for them.

The syndrome, associated with coronavirus, was first reported in the UK in mid-April 2020 and triggered an NHS England National Alert. The Royal College of Paediatrics and Child Health issued guidance about the emerging syndrome in early May 2020. It has overlapping features with Kawasaki disease (a very rare condition that mainly affects children under the age of five) but is more common in older children and teenagers. One other major difference is that patients with PIMS-TS can develop life-threatening shock – a condition where not enough blood is being pumped around the body.  

PIMS-TS symptoms vary from patient to patient, but researchers found that all patients had a fever. Other typical symptoms include heart problems such as dilated coronary arteries and excess fluid surrounding the heart, conjunctivitis, gastrointestinal problems and shock.

Clinicians studied 183 children from 13 different countries in Europe, Asia and America, making it the first international study to investigate PIMS-TS. The children had an average age of seven, with 60 per cent reporting current or recent infection with Covid-19. Obesity was noted as the most common underlying health condition and was present in 25 per cent of the children. Of the 183 children, 39 per cent required intravenous inotropic drugs, 23 per cent required mechanical ventilation, and two per cent required ECMO. Very sadly, three children died, all of whom were younger than two.

The study also found that the quicker children deteriorated before being admitted to hospital, the more likely they were to become seriously ill and need treatment such as extracorporeal membrane oxygenation (ECMO) – a life support system where blood is pumped out of the body and into an artificial heart and lung machine that adds oxygen to the blood, before returning it to the body, allowing the heart and lungs to rest.

Professor Fraisse, principal investigator, said: “An important finding from our research is that even the sickest children with PIMS-TS, many of whom experience severe heart failure, usually recover. However, during the early phase of the disease we found that half of the patients required intensive care treatment and were in a potentially life-threatening situation. So, it is very important to identify ways we can predict which children will become the sickest patients.”

Dr Bautista, who suggested performing the international online survey of PIMS-TS patients, said: “Our study not only found that the quicker children deteriorate the more likely they are to require intensive treatment, but also that 45 per cent of children with the syndrome had potentially life-threatening shock. These findings may lead to a quicker diagnosis of PIMS-TS, which is still a very new disease that we do not know much about.”

The syndrome affects multiple organs, but children usually go to hospital with severe heart failure. Patients are currently being assessed and treated by a multidisciplinary team from St Mary’s Hospital and Royal Brompton Hospital. Larger studies are now needed to establish how this syndrome is linked to Covid-19 and the best way to treat it.

The research was reported on by Reuters Health.