Multicenter registry of multisystem inflammatory syndrome in children (MIS-C) and Paired comparison with Kawasaki
Yi-Fang Wang1, Chun-Min Fu2, Kun-Lang Wu3
1Department of Pediatrics, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
Objectives:
This study aimed to identify clinical characteristics to differentiate multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) in Taiwan, an island with a delayed cluster of MIS-C and a high incidence of KD. Additionally, we studied risk factors for developing severe complications in patients with MIS-C.
Methods:
We conducted a retrospective, multicenter, cohort, and observational study that linked data on patients with MIS-C between May and December 2022 and patients with KD between 2019 and 2021 from 12 medical centers. Hemodynamic compromise, defined as the need for inotropic support or fluid challenge, was recorded in patients with MIS-C. We also evaluated maximal coronary Z-scores before treatment and one month after disease onset.
Results:
A total of 83 patients with MIS-C and 466 patients with KD were recruited. A 1:1 age and gender-matched comparison of 68 MIS-C and KD pairs showed that MIS-C patients had a lower percentage of positive BCG red halos, lower leukocyte/platelet counts, more gastrointestinal symptoms, and a higher risk of hemodynamic compromise. In Taiwan, 38.6% of MIS-C patients experienced hemodynamic compromise, with presence of conjunctivitis and elevated levels of procalcitonin (>1.62 ng/mL) identified as independent risk factors.
Conclusion:
We identified two independent risk factors associated with hemodynamic compromise in MIS-C patients. The comparison between matched MIS-C and KD patients highlighted significant differences in clinical presentations, like BCG red halos, which may aid in the differential diagnosis of the two disease entities, especially in regions with a high incidence rate of KD.
Insights
Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) can be differentiated by clinical signs like BCG red halos. Identifying risk factors for MIS-C complications, such as conjunctivitis, is crucial for early intervention.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Taiwan experiences a high incidence of Kawasaki disease (KD) and a delayed cluster of multisystem inflammatory syndrome in children (MIS-C).
- Differentiating MIS-C from KD is critical for appropriate management and to identify severe complications.
- Understanding risk factors for severe MIS-C is essential for timely intervention.
Purpose of the Study:
- To identify clinical characteristics distinguishing MIS-C from KD in Taiwan.
- To investigate risk factors for severe complications in MIS-C patients.
Main Methods:
- A retrospective, multicenter, observational cohort study comparing MIS-C (n=83) and KD (n=466) patients.
- 1:1 age and gender-matched analysis of 68 MIS-C and KD pairs.
- Evaluation of hemodynamic compromise and maximal coronary Z-scores.
Main Results:
- MIS-C patients showed fewer positive BCG red halos, lower leukocyte/platelet counts, more GI symptoms, and higher risk of hemodynamic compromise compared to KD.
- 38.6% of MIS-C patients in Taiwan experienced hemodynamic compromise.
- Conjunctivitis and elevated procalcitonin (>1.62 ng/mL) were independent risk factors for hemodynamic compromise in MIS-C.
Conclusions:
- Clinical differences, such as BCG red halos, can aid in differentiating MIS-C and KD, particularly in high KD incidence regions.
- Conjunctivitis and elevated procalcitonin are significant risk factors for hemodynamic compromise in MIS-C.
- This study provides valuable insights for the differential diagnosis and management of MIS-C and KD in Taiwan.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies