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Table 1 Patients characteristics

From: Anakinra in pediatric acute fulminant myocarditis

  Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8
Demographics  
 Age (years) 14 13 1 4 1 9 10 5
 Weight (kg) 62 86 8.2 17 7.9 38.9 38 24.5
 Sex Male Female Male Male Male Female Male Male
 Comorbidity No Obesity Fallot tetralogy No No No No No
Clinical condition
 Cardiogenic shock Yes Yes No No Yes Yes No No
 Ventricular arrythmia Yes No No No Yes No No No
 MAS No Yes Yes Yes No No No No
Cardiac evaluation at admission
 LVEF (%) 37 30 45 37 29 32 40
 Subaortic VTI (cm) 13 18 14 8 12 13 14
 LV dilatation No No No No No No No No
 MI (grade) Grade I Grade I Grade I Grade III Grade II Grade II Grade I
 RV dysfunction Yes No No No No No No No
 ECG Fleeting ventricular arrhythmia Normal Normal Normal Vf bursts, st segment elevation Normal Normal Normal
Laboratory findings at admission
 CRP (mg/l) 310 333 150 94 10 288 248 196
 PCT (μg/l) 84.87 15.8 28.7 2.63 0.26 6.19 161.29 3.81
 Wbcs (/mm3) 19,900 4870 16,690 11,230 10,260 17,090 5980 20,000
 Lymphocytes (/mm3) 1350 370 1670 1680 2870 1590 950 1280
 Neutrophils (/mm3) 17,270 4270 12,520 7640 6870 14,520 4800 18,260
 Serum creatinine (μmol/l) 133 79 31 32 37 59 39 30
 NT pro BNP (ng/l) 16,931 20,865 4269 2231 61,079 2591 7444 4105
 PCR SARS-CoV-2 (blood) Negative Negative Positive Positive Negative Negative Negative Positive
 IgG SARS-CoV-2 Positive Positive Negative Positive Negative Positive Positive Negative
 Other virus (blood) No No No No PB19 (IgG + , IgM -, PCR -) No No No
Treatment
 Immunotherapy Anakinra
 + IVIg
Anakinra
 + IVIg + CS
Anakinra + IVIg+ CS Anakinra
 + IVIg + CS
Anakinra
 + IVIg
Anakinra + CS Anakinra
 + CS
Anakinra + CS
 Reason for initiating anakinra Poor hemodynamic tolerance of IVIg Poor hemodynamic tolerance of IVIg MAS (bone marrow analysis, high blood ferritin and triglycerides) Poor hemodynamic tolerance of IVIg Severity of clinical picture Severity of clinical picture Major inflammatory state Major inflammatory state
 Time to start anakinra after admission (days) 0 1 8 0 3 1 0 2
Total anakinra treatment time (days) 14 15 11 7 4 1 3 3
 Anakinra dosage per day 200 mg 200 mg 6 mg/kg 4 mg/kg 4 mg/kg 2 mg/kg 4 mg/kg 4 mg/kg
 Max VIS score 55 5 160 0 1275 20 0 0
Total inotropic/ vasopressor support duration (days) 1 1 4 0 4 2 0 0
 Diuretic Yes Yes No No Yes Yes No No
 Other cardiovascular therapy No No Milrinone No Milrinone; amiodarone; levosimendan No No No
 Length of stay in ICU (days) 6 7 19 3 23 6 1 3
 Length (days) of non-invasive ventilation 0 4 0 0 1 0 0 0
 Length (days) of invasive ventilation 0 0 6 0 18 0 0 0
  1. Vasoactive-Inotropic Score (VIS) = dopamine dose (μg/Kg/min) + dobutamine dose (μg/Kg/min) + 100 × epinephrine dose (μg/Kg/min) + 10 × milrinone dose (μg/Kg/min) + 10,000 × vasopressin dose (U/Kg/min) + 100 × norepinephrine dose (μg/Kg/min)
  2. BMI body mass index, MI mitral insufficiency, TTE transthoracic echocardiogram, LVEF left venticular ejection fraction, VTI aortic velocity time integral, ECG electrocardiogram, VF ventricular fibrillation, CRP C-reactive protein, PCT procalcitonin, WBCs white blood cells, MAS Macrophage Activation Syndrome, PB19 B19 Parvovirus, IVIg, immunoglobulins, CS corticosteroids