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Severity of multisystem inflammatory syndrome in children (MIS-C) in patients with and without mucocutaneous findings
Megana Rao1, Caitlin Bond2, Anita Haggstrom3
1Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Mucocutaneous symptoms in children with MIS-C (multisystem inflammatory syndrome in children) were common but not linked to severe cardiac outcomes. Black children and those over 5 years old had higher odds of severe MIS-C.
Area of Science:
- Pediatric infectious diseases
- Cardiology
- Dermatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition with varied presentations.
- Few studies have compared MIS-C severity with mucocutaneous symptoms, age, race, and ethnicity.
Purpose of the Study:
- To describe mucocutaneous symptoms in MIS-C patients upon admission.
- To evaluate the correlation between mucocutaneous symptoms and MIS-C disease severity.
Main Methods:
- Retrospective cohort study of hospitalized patients with suspected MIS-C.
- Data collected from May 2020 to April 2021.
Main Results:
- 84.8% of patients exhibited mucocutaneous findings, including rash, conjunctivitis, cracked lips, and sore throat.
- Mucocutaneous symptoms were associated with lower troponin levels (a marker of cardiac injury).
- Black children and children aged 5 years or older had higher odds of severe MIS-C.
Conclusions:
- Mucocutaneous symptoms in MIS-C did not correlate with other markers of cardiac involvement.
- Limitations include small sample size and lack of on-site dermatological assessment.
Background:
There are few studies comparing severity of MIS-C disease with mucocutaneous symptoms, age, race, and ethnicity.
Objective:
To describe the mucocutaneous symptoms present on admission and evaluate whether these symptoms are correlated with a more severe MIS-C disease course.
Methods:
Retrospective cohort study of hospitalized patients with suspected MIS-C between May 13, 2020 to April 21, 2021.
Results:
Of the 66 patients who met the inclusion criteria, 84.8% (56/66) exhibited mucocutaneous findings. The most common mucocutaneous symptoms were rash, conjunctivitis, cracked lips, and sore throat. Children with mucocutaneous symptoms were younger (median 9.8 years) compared to those without (11.4 years), p = .39. The groups had similar proportions of pediatric intensive care unit admission, abnormal cardiology studies, and necessity of pressors. The presence of mucocutaneous findings on admission was associated with a lower troponin level on admission (median 0.08 ng/ml vs. 0.52, p = .003). Black children had higher odds of severe MIS-C compared to White children (odds ratio [95% CI]: 3.30 [1.02, 10.72], p = .047). Children ≥5 years of age had greater odds of severe MIS-C compared to children <5 years of age (odds ratio [95% CI]: 5.43 [1.39, 21.23], p = .02).
Limitations:
The sample size was relatively small, there was no dermatologist present on admission, initial diagnostic testing and management varied if patients presented at outside hospitals, and the CDC case definition for MIS-C was highly sensitive.
Conclusion:
The presence of mucocutaneous symptoms negatively correlated with troponin levels, but there was no significant association between these symptoms and other markers of cardiac involvement (echocardiogram, ejection fraction, electrocardiogram).
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