Related Experiment Video
Updated: May 21, 2025
Author Spotlight: Unveiling the Polyfunctionality and Heterogeneity in Immune Responses
Published on: March 8, 2024
Clinical and laboratory markers defining MIS-C and hyperinflammation in COVID-19: a cross-sectional study in a
Ana Paula Radünz Vieira1, Paulo Roberto Antonaccio Carvalho2, Sandra Helena Machado3
1Pediatric Rheumatology Division, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Santa Cecília, Porto Alegre City, Rio Grande do Sul, 90035-903, Brazil. anapaularadunz@gmail.com.
Insights
This study compares Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19-related hyperinflammation. MIS-C often presents with altered mental status, while hyperinflammation is linked to respiratory symptoms and higher ferritin levels.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- COVID-19 can cause severe inflammatory complications in children, including MIS-C and hyperinflammation.
- A gap exists in comparative studies differentiating MIS-C from other hyperinflammatory conditions post-COVID-19.
Purpose of the Study:
- To compare the clinical and laboratory characteristics of MIS-C and hyperinflammation in pediatric patients following COVID-19.
- To identify distinct diagnostic and prognostic markers for these conditions.
Main Methods:
- Retrospective longitudinal study analyzing demographic, clinical, and laboratory data.
- Inclusion criteria: COVID-19 exposure/infection, fever, multi-system involvement, age up to 21 years.
- Exclusion criteria: Lack of inflammatory markers or alternative diagnoses; ROC curve analysis performed.
Main Results:
- Fifty-four patients analyzed (31 MIS-C, 23 hyperinflammation).
- MIS-C associated with altered mental status (61% vs 46%) and conjunctival hyperemia (29% vs 4%).
- Hyperinflammation associated with respiratory dysfunction (57% vs 13%) and elevated ferritin (94% vs 77%).
- Key lab differences: MIS-C showed hypoalbuminemia, increased troponin, D-dimers, and BNP; hyperinflammation showed higher ferritin.
Conclusions:
- Altered mental status is more indicative of MIS-C, whereas respiratory symptoms suggest hyperinflammation.
- Specific laboratory markers like hypoalbuminemia, troponin, BNP, and D-dimers are more prevalent in MIS-C.
- Hyperferritinemia is a key indicator for the hyperinflammation group.
- Further research needed to establish cutoff points for biomarkers in pediatric MIS-C diagnosis and prognosis.
Background:
Numerous inflammatory complications related to COVID are described, including the Multisystem inflammatory Syndrome in Children (MIS-C) and Hyperinflammation. There is a scarcity of studies comparing these two groups.
Methods:
Retrospective longitudinal outcome-conditioned study. Demographic, clinical, and laboratory variables are analyzed. Patients with history of COVID contact or infection with at least 24 h of fever, two or more systems involved and up to 21 years were included. Patients with no laboratory signal of inflammation or with other diagnoses for the condition were excluded. Demographic and laboratory data are presented as medians with interquartile ranges. Dichotomous variables and prevalences are reported as percentages. A ROC curve analysis was conducted to assess the discriminatory ability of these tests in relation to the MIS-C and hyperinflammation groups.
Results:
We present fifty-four patients, thirty-one with MIS-C and twenty-three with hyperinflammation. The most frequent symptom in the MIS-C group was altered mental status in 61% vs. 46% (p = 0.014) and conjunctival hyperemia in 29% vs. 4% (p = 0.032). The most frequent laboratory findings were hypoalbuminemia in 68% vs. 26% (p = 0.002), increased serum troponin in 42% vs. 26% (p = 0.034), increased d-dimers in 94% vs. 76% (p = 0.015), as well as increased BNP in 55% vs. 17% (p = 0.02). On the other hand, the hyperinflammation group more frequently presented respiratory dysfunction in 57% vs. 13% (p = < 0.001) and serum ferritin equal or greater than 500 ng/mL in 94% vs. 77% (p = 0.046).
Conclusions:
This is an original study comparing clinical and laboratory findings between MIS-C and hyperinflammation due to COVID. Altered mental status is more frequently associated with MIS-C while respiratory symptoms are associated with hyperinflammation. In addition, regarding laboratory tests, there is hypoalbuminemia, increase in serum troponin, BNP, and D-dimers specially in the MIS-C group and hyperferritinemia in the hyperinflammation group. Further studies are needed to assess the cutoff point of biological markers such as BNP, troponin, and d-dimers for diagnosis and/or prognosis in the pediatric population with MIS-C.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...