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Prevalence, Comparative Risk, and Predictors of Shock in Children With Multisystem Inflammatory Syndrome Associated
Asif Jan1,2,3, Bushra Waheed4, Ghadah Ali Hussein5
1Department of Pharmacy, University of Peshawar, Peshawar, KP, Pakistan.
Journal of Paediatrics and Child Health
|June 11, 2026
Summary
Multisystem inflammatory syndrome in children (MIS-C) frequently causes shock, a serious complication. Early cardiovascular assessment is crucial for recognizing high-risk children and improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition linked to SARS-CoV-2.
- Cardiovascular dysfunction, particularly shock, is a common and critical complication of MIS-C.
- Early identification of shock in MIS-C is vital for reducing mortality and morbidity.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence, comparative risk, and predictors of shock in children with MIS-C.
- To enhance clinical management strategies for MIS-C.
- To guide future research directions in MIS-C.
Main Methods:
- Systematic search of PubMed, Embase, and Web of Science databases.
- Inclusion of observational studies reporting prevalence, comparative risk, or predictors of shock in MIS-C.
- Random-effects meta-analysis with Freeman-Tukey transformation for pooled prevalence and relative risks, with subgroup and sensitivity analyses to address heterogeneity.
Main Results:
- Seventy studies involving 13,263 children with MIS-C were analyzed.
- The pooled prevalence of shock was 56% (95% CI: 49%-63%), with significant heterogeneity observed.
- MIS-C was associated with a significantly increased risk of shock compared to Kawasaki disease and acute/severe COVID-19 without MIS-C. Echocardiographic abnormalities, myocardial dysfunction, elevated inflammatory markers, and acute kidney injury were key predictors.
Conclusions:
- Shock is a frequent and serious complication of MIS-C, despite limitations in evidence certainty due to heterogeneity.
- Early cardiovascular assessment and prompt recognition of high-risk children are essential for managing MIS-C.
- Further research is needed to refine understanding and management of shock in MIS-C.
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