A multicenter study of clinical and biochemical profiles, treatments, and short-term outcomes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection from Western India

Abstract

Background: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection can lead to multisystem inflammatory syndrome in children (MIS-C). This study was conducted to study epidemiology, clinical profile, treatment strategies associated in children MIS-C in two cities in Western India. Subjects and Methods: This is a retrospective, observational study of children who fulfilled the criteria for MIS-C, admitted to eleven pediatric intensive care units (PICUs) in Western India during the first wave SARS-CoV-2 infection in India, between February 2020 and December 2020. Demographic and clinical data including laboratory parameters, treatment regimens, and outcomes were collected and analyzed. Results: Of the 234 children presenting with MIS-C, they were categorized into 3 clinical phenotypes: fever and hyperinflammation, Kawasaki disease (KD)-like, and shock with multisystem organ dysfunction syndrome (MODS). C-reactive protein, procalcitonin (PCT), D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. Intravenous immunoglobulin (IVIG) was used in 128 (54.7%), corticosteroids in 214 (91.45%), tocilizumab in 1 (0.4%), and remdesivir in 4 (1.7%). 95 (40.5%) children required vasopressors and invasive mechanical ventilation was necessary in 26 (11.1%). Two hundred and twenty-nine patients were discharged home with median duration of PICU stay of 4 days and hospital stay of 7 days, and 5 (2.1%) patients died during treatment. Significant reduction in the duration of hospital stay was observed in those who received both steroid and IVIG (P < 0.05) and also in the shock ± MODS group (P < 0.05). Conclusions: Combination of steroid and IVIG for the treatment of MISC, especially with Shock and MODS reduce the duration of PICU stay than treated with steroid alone.

Clinical profile and outcome of patients admitted as multisystem inflammatory syndrome in children in a paediatric tertiary care hospital of North India

“…3,4 Biological differences (genetic and epigenetic) between males and females may affect the immune response to SARS-CoV-2 infection. 5 Median age of presentation in our study was 7 years consistent with the findings of study by Soma et al 6 In our study population, only 18% of the patients were positive for COVID antigen while as 81% patients (30) were positive for COVID antibody. Four patients tested positive for SARS-CoV-2 by RT-PCR, which generally reflects an acute phase of the infection, although the virus or its fragments may be detected for longer periods in some patients and could be responsible for these results, outside the classical period of positivity of the acute phase of COVID-19.…”

Clinical Profile of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Admitted to Pediatric Intensive Care Unit

“…Female predominance with 41 cases (54.67%) was noted in our study, in contrast to a higher number of male children documented in various other cohorts. 8 9 10 MIS-C is known to present with various phenotypes including KD like, toxic shock syndrome, HLH, and MAS. 6 11 12 13 14 KD with shock was an additional stratification during the second wave, and acute febrile inflammatory state was classified as nonspecific presentation.…”

“…Shock ( n = 51, 68%) was the predominant presentation in our cohort like the findings in other studies. 8 10 13 15 There were seven cases of KD with shock.…”

“…Gastrointestinal system involvement was the second most predominant presentation in our cohort, with diarrhea being the most common presentation unlike few studies. 7 9 10 There were two cases of acute abdomen—acute appendicitis, bowel gangrene. Left ventricular dysfunction due to possible myocarditis was found in 42.6% of the cases, and coronary involvement was seen in five cases in the PICU but others were not followed up.…”

“…Mortality accounted for 2.1% during the treatment. 10 Feldstein et al showed that the median duration of hospitalization was 7 days (IQR 4–10) with 20% requiring mechanical ventilation. Mortality was 2%.…”