Key result
Hemodynamic disorders predict ~24-fold higher odds of ICU admission in children with MIS-C.
Why the study?
MIS-C is difficult to diagnose and has a severe course requiring intensive care unit admission in half of cases, prompting investigation into factors associated with severe illness.
What are the predictors of a severe course of MIS-C requiring ICU admission in children?
Observational (n=166)
Yes
What are the predictors of a severe course of MIS-C requiring ICU admission in children?
Odds Ratio: 24.3 (95% CI 10.4–57)
Absolute Event Rate: 75% vs 11%
p-value: p=<0.001
In children with MIS-C, older age, cardiovascular involvement, and elevated inflammatory markers are key predictors of a severe disease course requiring ICU admission.
May flag MIS-C children with shock for ICU triage; leaves open prospective validation and intervention effects.
BACKGROUND:Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases. AIM:To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit. MATERIALS AND METHODS:The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of multisystem inflammatory syndrome associated with COVID-19 in children. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 patients hospitalized in the intensive care unit (n= 84, 50.6%), and group 2 patients who did not need hospitalization in the intensive care unit (n= 82, 49.4%). RESULTS:Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed. CONCLUSIONS:The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.
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Avrusin et al. (2023) conducted an observational in Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) (n=166). Shock/hypotension vs. Absence of shock/hypotension was evaluated on Admission to the intensive care unit (ICU) (OR 24.3, 95% CI 10.4-57.0, p=<0.001). Hemodynamic disorders such as shock or hypotension strongly predicted the need for intensive care unit admission in children with COVID-19-associated multisystem inflammatory syndrome (OR 24.3).
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