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Multisystem inflammatory syndrome in children (MIS-C) and sepsis differentiation by a clinical and analytical score:
María Hernández-García1,2, Elies Roldan-Berengue3, Carmina Guitart2,4
1Paediatrics Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.
Insights
Diagnosing Multisystem Inflammatory Syndrome in Children (MIS-C) and sepsis is challenging. The new MISSEP score effectively differentiates MIS-C from sepsis using clinical criteria, aiding timely treatment.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric rheumatology
Background:
- Distinguishing Multisystem Inflammatory Syndrome in Children (MIS-C) from sepsis is clinically complex.
- Accurate and early diagnosis is crucial for improving patient prognosis in both MIS-C and sepsis.
- Overlapping clinical presentations necessitate reliable diagnostic tools.
Purpose of the Study:
- To identify key differences between pediatric patients diagnosed with MIS-C and sepsis.
- To develop and validate a diagnostic score (MISSEP score) to differentiate MIS-C from sepsis.
Main Methods:
- Retrospective study comparing demographic, clinical, and laboratory data of MIS-C and sepsis patients admitted to a Pediatric Intensive Care Unit (PICU).
- Development of a diagnostic score using logistic regression analysis based on differentiating variables.
- Evaluation of the MISSEP score's sensitivity and specificity in discriminating between MIS-C and sepsis.
Main Results:
- MIS-C patients were older (10 vs. 4 years) and predominantly male (69%) compared to sepsis patients.
- Key differentiating clinical features included prolonged fever, skin-mucosal, and gastrointestinal symptoms in MIS-C.
- MIS-C showed higher rates of thrombocytopenia, lymphopenia, elevated fibrinogen, and myocardial dysfunction; sepsis had higher leukocytes, PCT, and ferritin.
- The MISSEP score, incorporating fever duration, thrombocytopenia, abdominal pain, conjunctival erythema, and Vasoactive Inotropic Score (VIS), achieved 89% sensitivity and 95% specificity for MIS-C.
Conclusions:
- The clinical phenotype of MIS-C significantly overlaps with sepsis, complicating differential diagnosis.
- The developed MISSEP score demonstrates high accuracy in distinguishing MIS-C from sepsis.
- The MISSEP score can be a valuable tool for clinicians to guide specific treatment strategies for MIS-C and sepsis.
Abstract:
Differential diagnosis between Multisystem Inflammatory Syndrome in Children (MIS-C) and other causes of systemic inflammatory response such as sepsis is complex. The aims were to evaluate the differences between pediatric patients with MIS-C and sepsis and to develop a score to distinguish both entities. This was a retrospective study that compared demographic, clinical, diagnostic, and therapeutic data of pediatric patients with MIS-C (cohort 2020-2022) and sepsis (cohorts 2010-2014 and 2017-2018) admitted to a Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. A diagnostic score was developed with variables that differentiated the two conditions. Twenty-nine patients with MIS-C were identified, who were matched 1:3 with patients with sepsis (n = 87). Patients with MIS-C were older (10 vs. 4 years old), and the majority were male (69%). Clinical characteristics that demonstrated differences were prolonged fever and signs and symptoms affecting skin-mucosa and gastrointestinal system. Leukocytes, PCT, and ferritin were higher in sepsis, while thrombocytopenia, lymphopenia, and elevated fibrinogen and adrenomedullin (biomarker with a role for the detection of invasive infections) were more frequent in MIS-C. MIS-C patients presented greater myocardial dysfunction (p < 0.001). Five criteria were selected and included in the MISSEP score after fitting them into a multivariate logistic regression model: fever > 48 hours (20 points), thrombocytopenia < 150 × 103/µL (6 points), abdominal pain (15 points), conjunctival erythema (11 points), and Vasoactive Inotropic Score (VIS) > 10 (7 points). The cutoff > 25 points allowed to discriminate MIS-C from sepsis with a sensitivity of 0.89 and specificity of 0.95. Conclusion: MIS-C phenotype overlaps with sepsis. MISSEP score could be useful to distinguish between both entities and direct specific treatment. What is Known: • Differential diagnosis between Multisystem Inflammatory Syndrome in Children (MIS-C) and other causes of systemic inflammatory response such as sepsis is complex. • It is essential to establish an accurate initial diagnosis and early specific treatment in both cases of MIS-C and sepsis to improve the prognosis of these patients. What is New: • Patients with MIS-C are older and have characteristic symptoms of prolonged fever, gastrointestinal symptoms, skin-mucosal involvement, and greater myocardial dysfunction, compared to patients with sepsis. • The use of diagnostic scores, such as the MISSEP score, can be very useful to distinguish between the two entities and help direct specific treatment.
