Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study
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Published on: September 7, 2022
Fabio Savorgnan1, Alvaro Moreira2, Axel Moreira1
1Department of Pediatrics, Division of Critical Care, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Insights
This study identified key physiological markers to stratify the severity of multisystem inflammatory syndrome in children (MIS-C). This helps clinicians predict which children require intensive care, improving patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Inflammatory disorders
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious complication.
- Accurate severity assessment is crucial for timely and appropriate medical intervention.
- Understanding the clinical and physiological profiles of MIS-C is essential for effective management.
Purpose of the Study:
- To describe the clinical presentation and physiological profile of children with varying degrees of MIS-C severity.
- To develop a method for stratifying MIS-C severity.
- To identify predictors of severe MIS-C.
Main Methods:
- Retrospective study of 152 children diagnosed with MIS-C.
- Development of an MIS-C severity score based on admission status, medication needs, and ventilation requirements.
- Univariate and multivariate analyses to identify risk factors associated with the severity score.
Main Results:
- A logistic regression model identified seven physiological variables strongly associated with severe MIS-C.
- These variables include elevated creatinine, international normalized ratio, brain natriuretic peptide, white blood cell count, ferritin, respiratory rate, and decreased albumin.
- This combination demonstrated excellent discrimination between mild and severe MIS-C (AUC = 0.915).
Conclusions:
- A distinct physiological profile is associated with the stratification of MIS-C severity.
- This profile aids in recognizing patients likely to require a higher level of intensive care.
- The derived nomenclature assists in classifying MIS-C severity for better clinical decision-making.
Objective:
The purpose of this study was to describe the clinical presentation and physiologic profile of individuals with varying degrees of severity of multisystem inflammatory syndrome in children (MIS-C).
Methods:
We performed a retrospective study of children diagnosed with MIS-C admitted to a single quaternary children's hospital from May 2020 to April 2021. We created an MIS-C severity score using the following parameters: hospital admission status (e.g., floor vs intensive care unit), need for inotropic or vasoactive medications, and need for mechanical ventilation. Univariate and multivariate analyses were performed to associate risk factors corresponding to the MIS-C severity score.
Results:
The study included 152 children who were followed for 14 days post hospital admission. A stepwise forward selection process identified seven physiologic variables associated with "severe" MIS-C according to a logistic regression. Specifically, a combination of elevated creatinine (p = 0.013), international normalized ratio (p = 0.002), brain natriuretic peptide (p = 0.001), white blood cell count (p = 0.009), ferritin (p = 0.041), respiratory rate (p = 0.047), and decreased albumin (p = 0.047) led to an excellent discrimination between mild versus severe MIS-C (AUC = 0.915).
Conclusion:
This study derived a physiologic profile associated with the stratification of MIS-C severity.
Impact:
Based on a cohort of 152 individuals diagnosed with MIS-C, this study derived a nomenclature that stratifies the severity of MIS-C. Investigated demographic, presentational vital signs, and blood analytes associated with severity of illness. Identification of a multivariate physiologic profile that strongly associates with MIS-C severity. This model allows the care team to recognize patients likely to require a higher level of intensive care.
