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Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With Covid-19 - Single-Center Experience
Poovazhagi Varadarajan1, S Elilarasi2, Ritchie Sharon Solomon3
1Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu. Correspondence to: Dr Poovazhagi Varadarajan, HOD and Professor, Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu. poomuthu@gmail.com.
Insights
Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 often presents with fever, vomiting, and shock. Poor outcomes are linked to acute kidney injury, HLH, and cardiac issues.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition linked to COVID-19.
- Understanding the clinical spectrum and outcomes of MIS-C is crucial for timely diagnosis and management.
Purpose of the Study:
- To characterize the clinical presentation, phenotypes, and outcomes of MIS-C in children.
- To identify factors associated with poor outcomes in MIS-C patients.
Main Methods:
- A prospective study enrolled 257 children with MIS-C from June 2020 to March 2022.
- Data collected included clinical features, laboratory results, intensive care admission, system involvement, and echocardiographic findings.
Main Results:
- Fever, vomiting, red eyes, and shock were common presenting features.
- 45.9% of children presented with shock, 44.4% with a Kawasaki-like phenotype.
- Left ventricular dysfunction (30.3%), acute kidney injury (13%), and HLH (13.6%) were significant system involvements. Overall mortality was 11.7%.
Conclusions:
- Kawasaki-like and shock-like presentations are frequent in MIS-C.
- Coronary abnormalities were observed in 45.9% of children.
- Acute kidney injury, HLH, mechanical ventilation, and mitral regurgitation predict poor outcomes in MIS-C.
Objectives:
To describe the clinical presentation, phenotype and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (Covid-19) from a tertiary care center in southern India.
Methods:
257 children fulfilling the inclusion criteria of MIS-C were prospectively enrolled from June, 2020 to March, 2022.
Results:
Median (range) age at presentation was 6 year (35 day to 12 years). Presenting features were fever (98%), vomiting (75.8%), red eyes (63%), rashes (49%), pain abdomen (49%), shock (45.9%), lymphopenia (73%, thrombocytopenia (58.3%) and anemia (45%). 103 (39.7%) children required intensive care admission. Shock phenotype, Kawasaki-like phenotype and no specific phenotype were diagnosed in 45.9%, 44.4%, and 36.6% children, respectively. Left ventricular dysfunction (30.3%), acute kidney injury (13%), acute liver failure (17.4%), and hemophagolymphohistiocytosis (HLH) (13.6%) were the major system involvement in MIS-C. Mitral regurgitation (P=0.029), hyperechogenic coronaries (P=0.006), Left ventricular dysfunction (P=0.001) and low ejection fraction (P=0.007) were significantly associated with shock. Overall mortality was 11.7%.
Conclusion:
Kawasaki-like and shock-like presentation were common in MIS-C. Coronary abnormalities were seen in 118 (45.9%) children. Children with acute kidney injury, HLH, need for mechanical ventilation, and echocardiogram evidence of mitral regurgitation in MIS-C have a poor outcome.
