From presentation to intensive care

Aim: Multisystem Inflammatory Syndrome in Children (MIS-C) is a hyperinflammatory condition associated with COVID-19 characterized by immune dysregulation that may lead to organ dysfunction and shock, with cardiac involvement being the most important manifestation. Patients often require PICU admission (43-88%) but usually with favorable outcomes. Elevated inflammatory markers, cardiac involvement and shock have been identified as major predictors of PICU admission. Methods: This retrospective multicenter study aimed to identify risk factors for PICU admission among MIS-C patients treated from 2020 to 2024 in Croatia. Demographic, clinical, laboratory and echocardiographic data were compared between PICU and non-PICU patients. Results: We analyzed 136 patient records treated for MIS-C with a 52.2% PICU admission rate. Elevated CRP levels along with myocarditis, congestive heart failure, mitral regurgitation and pleural effusion were significantly more common in the PICU group. Multivariate analysis identified CRP (per 10 mg/L increase, aOR 1.10, 95% CI: 1.03–1.18, p = 0.002), myocarditis (aOR 3.04, 95% CI: 1.10–9.16, p = 0.038) and mitral regurgitation (aOR 2.87, 95% CI: 1.24–6.93, p = 0.016) as factors associated with PICU admission. Conclusion: Considering the potential severity of the disease, prompt recognition of risk factors and early echocardiographic evaluation are crucial for early assessment of cardiac involvement and the need for intensive care. In this context, our findings indicate that mitral regurgitation, myocarditis, and elevated CRP levels are important indicators of increased risk, as they were associated with a higher likelihood of PICU admission.