Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York...

Area of Science:

• Pediatric critical care medicine
• Pediatric infectious diseases
• Pediatric rheumatology

Background:

• Multisystem inflammatory disease in children (MIS-C) can lead to shock, a critical complication.
• Early identification of patients at risk for delayed shock is essential for timely intervention.
• Predicting shock development in MIS-C is challenging due to its complex presentation.

Purpose of the Study:

• To identify independent predictors of delayed shock (≥3 hours from ED arrival) in MIS-C patients.
• To develop a predictive model for identifying MIS-C patients at low risk of delayed shock.
• To improve risk stratification and guide clinical management of MIS-C.

Main Methods:

• Retrospective cross-sectional study across 22 pediatric emergency departments.
• Inclusion of patients meeting WHO criteria for MIS-C from April to June 2020.
• Analysis of clinical and laboratory factors associated with delayed shock development.

Main Results:

• Of 248 MIS-C patients, 35% experienced shock, with 66% of those developing delayed shock.
• Independent predictors for delayed shock included CRP > 20 mg/dL, lymphocyte percent < 11%, and platelet count < 220,000/uL.
• A low-risk prediction model (CRP < 6 mg/dL, lymphocyte percent > 20%, platelet count > 260,000/uL) showed 93% sensitivity for identifying patients not progressing to delayed shock.

Conclusions:

• Serum CRP, lymphocyte percentage, and platelet count effectively differentiate risk for delayed shock in MIS-C.
• These laboratory markers can stratify MIS-C patients by shock progression risk.
• The findings aid in situational awareness and guiding the level of care for MIS-C patients.