دورية أكاديمية
Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents.
| العنوان: | Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents. |
|---|---|
| المؤلفون: | Geva A; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston,1These authors contributed equally to this work.2A complete list of members and affiliations is provided in the Supplementary Appendix. MA, USA.; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA.; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA., Patel MM; COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA., Newhams MM; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston,1These authors contributed equally to this work.2A complete list of members and affiliations is provided in the Supplementary Appendix. MA, USA., Young CC; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston,1These authors contributed equally to this work.2A complete list of members and affiliations is provided in the Supplementary Appendix. MA, USA., Son MBF; Department of Pediatrics, Division of Immunology, Boston Children's Hospital, Boston, MA, USA., Kong M; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA., Maddux AB; Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA., Hall MW; Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA., Riggs BJ; Department of Anesthesiology and Critical Care Medicine; Division of Pediatric Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Singh AR; Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY, USA., Giuliano JS; Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, CT, USA., Hobbs CV; Department of Pediatrics, Division of Disease; Microbiology; University of Mississippi Medical Center, Jackson, MS, USA., Loftis LL; Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA., McLaughlin GE; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA., Schwartz SP; Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC, USA., Schuster JE; Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA., Babbitt CJ; Miller Children's and Women's Hospital of Long Beach, Long Beach, CA, USA., Halasa NB; Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Gertz SJ; Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ, USA., Doymaz S; Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA., Hume JR; Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA., Bradford TT; Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, LA, USA., Irby K; Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, USA., Carroll CL; Division of Critical Care, Connecticut Children's, Hartford, CT, USA., McGuire JK; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA., Tarquinio KM; Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA., Rowan CM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA., Mack EH; Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA., Cvijanovich NZ; Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, CA, USA., Fitzgerald JC; Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA., Spinella PC; Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO, USA., Staat MA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA., Clouser KN; Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA., Soma VL; Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, NY, USA., Dapul H; Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, NY, USA., Maamari M; Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center Dallas, TX, USA., Bowens C; Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Louisville, and Norton Children's Hospital, Louisville, KY, USA., Havlin KM; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University, Detroit, MI, USA., Mourani PM; Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA., Heidemann SM; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University, Detroit, MI, USA., Horwitz SM; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Feldstein LR; COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA., Tenforde MW; COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA., Newburger JW; Department of Cardiology, Boston Children's Hospital, Boston, MA, USA., Mandl KD; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA.; Departments of Biomedical Informatics and Pediatrics, Harvard Medical School, Boston, MA, USA., Randolph AG; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston,1These authors contributed equally to this work.2A complete list of members and affiliations is provided in the Supplementary Appendix. MA, USA.; Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA, USA. |
| مؤلفون مشاركون: | Overcoming COVID-19 Investigators |
| المصدر: | EClinicalMedicine [EClinicalMedicine] 2021 Oct; Vol. 40, pp. 101112. Date of Electronic Publication: 2021 Aug 31. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: The Lancet Country of Publication: England NLM ID: 101733727 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2589-5370 (Electronic) Linking ISSN: 25895370 NLM ISO Abbreviation: EClinicalMedicine Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: [London] : The Lancet, [2018]- |
| مستخلص: | Background: Multisystem inflammatory syndrome in children (MIS-C) consensus criteria were designed for maximal sensitivity and therefore capture patients with acute COVID-19 pneumonia. Methods: We performed unsupervised clustering on data from 1,526 patients (684 labeled MIS-C by clinicians) <21 years old hospitalized with COVID-19-related illness admitted between 15 March 2020 and 31 December 2020. We compared prevalence of assigned MIS-C labels and clinical features among clusters, followed by recursive feature elimination to identify characteristics of potentially misclassified MIS-C-labeled patients. Findings: Of 94 clinical features tested, 46 were retained for clustering. Cluster 1 patients ( N = 498; 92% labeled MIS-C) were mostly previously healthy (71%), with mean age 7·2 ± 0·4 years, predominant cardiovascular (77%) and/or mucocutaneous (82%) involvement, high inflammatory biomarkers, and mostly SARS-CoV-2 PCR negative (60%). Cluster 2 patients ( N = 445; 27% labeled MIS-C) frequently had pre-existing conditions (79%, with 39% respiratory), were similarly 7·4 ± 2·1 years old, and commonly had chest radiograph infiltrates (79%) and positive PCR testing (90%). Cluster 3 patients ( N = 583; 19% labeled MIS-C) were younger (2·8 ± 2·0 y), PCR positive (86%), with less inflammation. Radiographic findings of pulmonary infiltrates and positive SARS-CoV-2 PCR accurately distinguished cluster 2 MIS-C labeled patients from cluster 1 patients. Interpretation: Using a data driven, unsupervised approach, we identified features that cluster patients into a group with high likelihood of having MIS-C. Other features identified a cluster of patients more likely to have acute severe COVID-19 pulmonary disease, and patients in this cluster labeled by clinicians as MIS-C may be misclassified. These data driven phenotypes may help refine the diagnosis of MIS-C. Competing Interests: All authors report receiving funding from the Centers for Disease Control and Prevention for the current study. AG reports receiving grants from the NIH outside of the submitted work. ABM reports receiving grants from the Francis Family Foundation and from the NIH/NICHD (K23HD096018) outside of the submitted work. CVH reports receiving consulting fees from DYNAMED and BIOFIRE outside of the submitted work. JES reports receiving grants from Merck outside of the submitted work. NBH reports receiving grants from Sanofi, Quidel, the NIH, and the CDC; consulting fees from Moderna; and an educational grant from Genetech outside of the submitted work. CMR reports receiving grants from the NIH/NHLBI (K23HL150244) outside of the submitted work. NZC reports receiving grants or contracts from Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center outside of the submitted work. JCF reports receiving grants from the NIH outside of the submitted work. HD reports payments from Delex Pharma International Inc. outside of the submitted work. PMM reports receiving grants from the NIH and serving as a member of data safety monitoring board for the NIH supported KIDS-DOT trial outside of the submitted work. AGR reports receiving royalties from UpToDate outside of the submitted work. All other authors have nothing to declare. (© 2021 The Authors.) |
| References: | Clin Chem. 2012 Jan;58(1):54-61. (PMID: 21965555) Lancet. 2020 May 23;395(10237):1607-1608. (PMID: 32386565) BMJ. 2020 Aug 27;370:m3249. (PMID: 32960186) Cell. 2020 Nov 12;183(4):968-981.e7. (PMID: 32966765) Ann Rheum Dis. 2020 Aug;79(8):999-1006. (PMID: 32527868) Lancet Respir Med. 2014 Aug;2(8):611-20. (PMID: 24853585) Nat Rev Dis Primers. 2019 Mar 14;5(1):18. (PMID: 30872586) JAMA. 2020 Jul 21;324(3):294-296. (PMID: 32511676) Lancet Child Adolesc Health. 2020 Sep;4(9):653-661. (PMID: 32593339) Circulation. 2021 Jan 5;143(1):4-6. (PMID: 32787714) JAMA. 2020 Jul 21;324(3):259-269. (PMID: 32511692) N Engl J Med. 2020 Jul 23;383(4):334-346. (PMID: 32598831) BMJ. 2020 Jun 3;369:m2094. (PMID: 32493739) MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1081-1088. (PMID: 32790664) Nat Med. 2020 Jun;26(6):845-848. (PMID: 32350462) Lancet. 2007 Oct 20;370(9596):1453-7. (PMID: 18064739) Allergy. 2020 Jul;75(7):1564-1581. (PMID: 32396996) Lancet. 2020 Jun 6;395(10239):1771-1778. (PMID: 32410760) JAMA. 2021 Mar 16;325(11):1074-1087. (PMID: 33625505) JAMA Pediatr. 2021 Aug 1;175(8):837-845. (PMID: 33821923) N Engl J Med. 2020 Jul 23;383(4):347-358. (PMID: 32598830) MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080. (PMID: 32790663) Euro Surveill. 2020 Jun;25(22):. (PMID: 32524957) |
| معلومات مُعتمدة: | R21 HD095228 United States HD NICHD NIH HHS; K23 DK119463 United States DK NIDDK NIH HHS; K12 HD047349 United States HD NICHD NIH HHS; P50 HD105351 United States HD NICHD NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS |
| فهرسة مساهمة: | Keywords: COVID-19; Clustering; Critical care medicine; Multisystem inflammatory syndrome; Pediatrics |
| تواريخ الأحداث: | Date Created: 20210906 Latest Revision: 20220426 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC8405351 |
| DOI: | 10.1016/j.eclinm.2021.101112 |
| PMID: | 34485878 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 2589-5370 |
|---|---|
| DOI: | 10.1016/j.eclinm.2021.101112 |