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Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study
Jordan E Roberts1,2, Jeffrey I Campbell2,3, Kimberlee Gauvreau2,4
1Pediatrics, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA Jordan.roberts2@childrens.harvard.edu.
Archives of Disease in Childhood
|July 10, 2021
Summary
Multisystem inflammatory syndrome in children (MIS-C) diagnosis is challenging due to overlapping symptoms with other febrile illnesses. Key distinguishing features include age, conjunctivitis, abdominal pain, hypotension, and specific lab markers like neutrophil/lymphocyte ratio and platelet counts.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) shares clinical features with various febrile illnesses, complicating early diagnosis.
- Accurate differentiation is crucial for timely and appropriate patient management.
Purpose of the Study:
- To identify distinct clinical and laboratory findings differentiating MIS-C from other febrile illnesses.
- To determine which conditions most frequently mimic MIS-C in a tertiary care setting.
Main Methods:
- Retrospective analysis of hospitalized children evaluated for MIS-C.
- Comparison of clinical, laboratory, and SARS-CoV-2 status between MIS-C positive and negative groups.
- Multivariable logistic LASSO regression to identify key discriminators.
Main Results:
- Conjunctivitis, abdominal pain, fatigue, hypoxemia, tachypnea, and hypotension were more frequent in MIS-C positive patients.
- While C-reactive protein (CRP) levels were similar, MIS-C was associated with thrombocytopenia, lymphopenia, elevated ferritin, neutrophil/lymphocyte ratio, BNP, and troponin.
- Multivariable analysis identified age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain, and hypotension as significant predictors.
Conclusions:
- Older children with MIS-C present with specific symptoms like conjunctivitis, oral mucosa changes, abdominal pain, and hypotension.
- Elevated neutrophil/lymphocyte ratios and lower platelet counts are characteristic of MIS-C.
- These findings aid in distinguishing MIS-C from overlapping conditions like bacterial lymphadenitis and viral infections.
