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Published on: August 7, 2017
Determination of Risk Factors for Severe Life-Threatening Course of Multisystem Inflammatory Syndrome Associated with
Ilia S Avrusin1, Natalia N Abramova2, Konstantin E Belozerov1
1Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia.
Insights
Identifying risk factors for severe Multisystem Inflammatory Syndrome in Children (MIS-C) is crucial. Older age, specific symptoms like hepatomegaly, and elevated biomarkers like D-dimer predict severe MIS-C requiring intensive care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious post-COVID-19 complication.
- MIS-C can lead to severe illness and intensive care unit (ICU) admission.
Purpose of the Study:
- To identify risk factors associated with a severe or life-threatening course of MIS-C.
- To determine predictors for ICU admission in pediatric MIS-C patients.
Main Methods:
- Comparative analysis of 166 MIS-C patients divided into ICU (n=84) and non-ICU (n=82) groups.
- Evaluation of clinical signs, laboratory markers (CRP, creatinine, troponin, D-dimer), and presence of macrophage activation syndrome.
Main Results:
- Severe MIS-C patients were older and presented more frequently with rash, swelling, hepatomegaly, splenomegaly, neurological, and respiratory symptoms.
- Hypotension/shock, myocardial involvement, elevated CRP, creatinine, troponin, and D-dimer were more common in severe cases.
- Macrophage activation syndrome was more prevalent in ICU-admitted patients.
Conclusions:
- Nineteen predictors of severe MIS-C were identified.
- Hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, and troponin > 10 pg/mL are early predictors of severe MIS-C requiring ICU admission.
Abstract:
Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a life-threatening condition that often requires intensive care unit (ICU) admission. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. The study included 166 patients (99 boys, 67 girls) aged 4 months-17 years (median 8.2 years). The criterion of severity was the fact of ICU admission. To conduct a comparative analysis, MIS-C patients were divided into two groups: patients hospitalized in the ICU (n = 84, 50.6%) and those who did not need ICU admission (n = 82, 49.4%). Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, and neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin, and D-dimer levels. Additionally, the presence of macrophage activation syndrome was higher in patients admitted to the ICU. Conclusion: Nineteen predictors of severe course of MIS-C were found, out of which hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, troponin > 10 pg/mL were mainly associated with the probability of being classified as early predictors of severe MIS-C requiring ICU admission.
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