Cardiogenic Shock Risk Score at Diagnosis of Multisystem Inflammatory Syndrome in Children: A Multicenter Study

Area of Science:

• Pediatric Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Severe cardiovascular involvement, including cardiogenic shock, is a critical concern in multisystem inflammatory syndrome in children (MIS-C), significantly impacting mortality.
• Early identification of children at risk for cardiogenic shock is crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To validate a previously developed cardiogenic shock risk score in a larger, multicenter cohort of pediatric patients with MIS-C.
• To develop and validate a new, more accurate screening tool for predicting cardiogenic shock at the time of MIS-C diagnosis.

Main Methods:

• A multicenter cohort of pediatric patients diagnosed with MIS-C between 2020 and 2023 was retrospectively analyzed.
• A previously published single-center risk score was tested, and factors associated with cardiogenic shock were identified using multivariate regression to build a new score.
• The new score incorporated age, presence of dyspnea, and C-reactive protein (CRP) levels.

Main Results:

• In 127 MIS-C patients (53% with cardiogenic shock), the new score demonstrated a sensitivity of 0.88 and a negative likelihood ratio of 0.23.
• Factors associated with cardiogenic shock included age > 8 years, delayed treatment, dyspnea, altered mental status, general deterioration, gastrointestinal symptoms, few Kawasaki signs, absence of rhinopharyngitis, elevated NT-proBNP, high CRP, and high leukocytes.
• The developed score (0.128*Age + 1.195*Dyspnea + 0.007*CRP - 2.6732) showed significant correlation with minimal left ventricular ejection fraction (ρ = 0.51, p < 0.001).

Conclusions:

• The previously published risk score's components remained associated with cardiogenic shock in the multicenter cohort.
• The newly developed screening tool, integrating age, dyspnea, and CRP, exhibits high sensitivity for identifying children with MIS-C at risk of cardiogenic shock.
• This new score offers a valuable, readily applicable tool for early risk stratification and management of cardiovascular complications in pediatric MIS-C.