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Risk factors for haemodynamic compromise in multisystem inflammatory syndrome in children: a multicentre
Kfir Kaidar1, Yotam Dizitzer2, Philip J Hashkes3
1Rheumatology Department, Schneider Children's Medical Centre, Petach Tikvah, Israel.
Insights
Predictors of severe multisystem inflammatory syndrome in children (MIS-C) requiring inotropic support were identified. Central nervous system involvement and high fever predicted severe MIS-C, while mucosal changes were protective.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious complication.
- Identifying predictors of severe MIS-C is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and laboratory predictors of severe multisystem inflammatory syndrome in children (MIS-C).
- To define severe MIS-C by the need for inotropic support.
Main Methods:
- Retrospective study of 100 MIS-C patients across 10 medical centers (July 2020-March 2021).
- Univariate and multivariate regression analyses assessed demographic, clinical, laboratory, and imaging variables.
- Odds ratios (OR) were calculated for severe disease predictors.
Main Results:
- Left ventricular dysfunction (OR 4.178) predicted severe MIS-C.
- Conjunctivitis (OR 0.403) and mucosal changes (OR 0.333) at admission were protective.
- Central nervous system involvement and fever >39.5°C were associated with severe disease in multivariate analysis.
- Low hemoglobin/platelets and elevated troponin were risk factors; mucosal involvement reduced risk by 6.2-fold.
Conclusions:
- Clinical and laboratory parameters during the disease course, not just at admission, predict severe MIS-C.
- Early identification of risk factors can guide closer monitoring and prompt treatment.
- Patients with Kawasaki-like features had a lower likelihood of requiring inotropic support.
Objectives:
To identify predictors of a severe clinical course of multisystem inflammatory syndrome in children (MIS-C), as defined by the need for inotropic support.
Methods:
This retrospective study included patients diagnosed with MIS-C (according to the CDC definition) in nine Israeli and one US medical centre between July 2020 and March 2021. Univariate and multivariate regression models assessed odds ratio (OR) of demographic, clinical, laboratory and imaging variables during admission and hospitalization for severe disease.
Results:
Of 100 patients, 61 (61%) were male; mean age 9.65 (4.48) years. Sixty-five patients were hypotensive, 44 required inotropic support. Eleven patients with MIS-C fulfilled Kawasaki disease diagnostic criteria; 87 had gastrointestinal symptoms on admission. Echocardiographic evaluation showed 10 patients with acute coronary ectasia or aneurysm, and 37 with left ventricular dysfunction. In a univariate model, left ventricular dysfunction was associated with severe disease [OR 4.178 (95% CI 1.760, 9.917)], while conjunctivitis [OR 0.403 (95% CI 0.173, 0.938)] and mucosal changes [OR 0.333 (95% CI 0.119, 0.931)] at admission were protective. Laboratory markers for a severe disease course were low values of haemoglobin, platelets, albumin and potassium; and high leukocytes, neutrophils, troponin and brain natriuretic peptide. In multivariate analysis, central nervous system involvement and fever >39.5°C were associated with severe disease. Mucosal involvement showed 6.2-fold lower risk for severe disease. Low haemoglobin and platelet count, and elevated C-reactive protein and troponin levels were identified as risk factors for severe disease.
Conclusion:
Key clinical and laboratory parameters of MIS-C were identified as risk factors for severe disease, predominantly during the disease course and not at the time of admission; and may prompt close monitoring, and earlier, more aggressive treatment decisions. Patients presenting with a Kawasaki-like phenotype were less likely to require inotropic support.
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