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Multisystem Inflammatory Syndrome in Children: An International Survey
Carles Bautista-Rodriguez1,2,3, Joan Sanchez-de-Toledo4,5,3, Bradley C Clark6,7
1Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom.
Insights
Multisystem inflammatory syndrome in children (MIS-C) presents with varied symptoms, from Kawasaki disease-like illness to shock. Shorter symptom duration before hospital admission is linked to worse outcomes in pediatric MIS-C patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition following SARS-CoV-2 infection.
- Understanding MIS-C's clinical spectrum and outcomes is crucial for timely intervention.
Purpose of the Study:
- To delineate the clinical presentation, hospital course, and predictors of adverse outcomes in children diagnosed with MIS-C.
- Identify factors associated with severe disease and poor prognosis in pediatric MIS-C.
Main Methods:
- Retrospective analysis of a case series involving 183 children diagnosed with MIS-C across 33 international hospitals.
- Data collection included clinical, laboratory, and imaging findings, as well as treatment management, via a web-based survey.
Main Results:
- The study included 183 MIS-C patients (mean age 7.0 years; 59.6% male; 30.6% Black).
- 62.3% had evidence of SARS-CoV-2 infection. Common presentations included fever (100%), gastrointestinal symptoms (63.9%), and shock (43.2%).
- A shorter duration of symptoms before admission was significantly associated with increased risk of poor outcomes, including extracorporeal membrane oxygenation or death (OR 0.723, P = .006).
Conclusions:
- MIS-C exhibits a broad clinical spectrum in children, ranging from Kawasaki disease-like presentations to severe shock and milder inflammatory forms.
- Early presentation with fewer symptoms before hospitalization is a critical predictor of worse outcomes in pediatric MIS-C.
Objectives:
To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C).
Methods:
Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management.
Results:
We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82; P < .0001) increased risk per day reduction respectively.
Conclusions:
In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.
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