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Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a
Qalab Abbas1, Haider Ali2, Fatima Amjad2
1Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan qalab.abbas@aku.edu.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a severe condition. Outcomes are worse in middle-income countries compared to high-income countries, highlighting the need for standardized care protocols.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is an evolving condition with a lack of standardized diagnostic and management protocols.
- Understanding clinical features, management, and outcomes is crucial for improving pediatric care.
- Variances in MIS-C presentation and outcomes between high-income countries (HIC) and middle-income countries (MIC) require investigation.
Purpose of the Study:
- To summarize the clinical and diagnostic features of MIS-C.
- To review management strategies and patient outcomes.
- To evaluate differences in MIS-C parameters and outcomes between HIC and MIC.
Main Methods:
- A systematic review and meta-analysis of observational studies (≥10 patients) published between December 2019 and March 2023.
- Searched four databases, pooling data using random effects models and mixed generalized linear models.
- Assessed publication bias and conducted subgroup analysis based on country income status.
Main Results:
- 120 studies (20,881 cases) were analyzed. Common symptoms included fever (99%), gastrointestinal (76.7%), and dermatological (63.3%).
- Intravenous immunoglobulins (87.5%) and steroids (74.7%) were common treatments. 53.1% required PICU admission.
- Overall mortality was 3.9%. Patients in MIC were younger, had more respiratory distress and cardiac dysfunction, longer ICU stays, and higher mortality than those in HIC.
Conclusions:
- MIS-C is a severe disease with significant disparities in outcomes between HIC and MIC.
- Patients in MIC face higher mortality rates and more severe presentations.
- Standardized protocols and further research are essential to optimize MIS-C care and reduce global inequities.
Background:
Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC).
Methods:
We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study.
Results:
A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC.
Conclusion:
MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC.
Prospero Registration Number:
CRD42020195823.
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