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Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study
Guntulu Sık1, Aysegul Inamlık2, Nihal Akçay3
1Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey. drguntulu@hotmail.com.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is serious. High D-dimer and CK-MB indicate longer PICU stays, while elevated leukocyte, lactate, and ferritin levels predict mortality in MIS-C patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric rheumatology
Background:
- Severe multisystem inflammatory syndrome in children (MIS-C) requires intensive care.
- Understanding clinical characteristics and mortality risk factors is crucial.
Purpose of the Study:
- To evaluate clinical features, outcomes, and mortality predictors in children with MIS-C.
- To identify factors associated with prolonged PICU stay and mortality.
Main Methods:
- Retrospective multicenter cohort study of 322 children with MIS-C admitted to 41 PICUs.
- Data collected from March 2020 to April 2021.
Main Results:
- Cardiovascular and hematological systems were most affected.
- High D-dimer and CK-MB levels correlated with longer PICU stays.
- Mortality was linked to renal, respiratory, neurological involvement, cardiac impairment, shock, higher leukocyte counts, lactate, ferritin, and mechanical ventilation.
Conclusions:
- High D-dimer and CK-MB levels predict longer PICU stay in MIS-C.
- Elevated leukocyte counts, lactate, and ferritin levels are associated with non-survival.
- Therapeutic plasma exchange showed no significant effect on mortality.
Background:
This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit.
Methods:
A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome.
Results:
The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation.
Conclusions:
In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
Impact:
MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
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